AI Article Synopsis

  • This study looks into how early signs of heart problems in children treated with anthracycline chemotherapy could lead to better outcomes, focusing on ECG changes before echocardiogram abnormalities appear.
  • Analysis involved 589 pediatric cancer patients, finding that 19.5% developed cardiomyopathy, with factors like older age and larger body size linked to higher risks.
  • Results showed that a decrease in QRS amplitudes and an increase in QT interval were strong indicators of developing cardiomyopathy, which in turn was associated with higher mortality rates.

Article Abstract

Background: Early recognition of anthracycline-induced cardiomyopathy may reduce morbidity and mortality in children, but risk stratification tools are lacking. This study evaluates whether electrocardiogram (ECG) changes precede echocardiographic abnormalities in children with anthracycline-induced cardiomyopathy.

Methods: We performed a retrospective analysis of 589 pediatric cancer patients who received anthracyclines at a tertiary referral center. ECG endpoints were sum of absolute QRS amplitudes in the 6 limb leads (ΣQRS(6 L)) and corrected QT interval (QTc). Cardiomyopathy was defined by echocardiogram as ejection fraction < 50%, shortening fraction < 26%, or left ventricular end-diastolic diameter z-score > 2.5.

Results: Median age at start of therapy was 7.8 years (IQR 3.7-13.6); median follow-up time was 3.6 years (IQR 1.1-5.8). 19.5% of patients met criteria for cardiomyopathy. Male sex, race, older age at first dose, and larger body surface area were associated with development of cardiomyopathy. A 0.6 mV decrease in ΣQRS(6 L) and 10 ms increase in QTc were associated with an increased risk of developing cardiomyopathy with hazard ratios of 1.174 (95% CI = 1.057-1.304,  = 0.003) and 1.098 (95%CI = 1.027-1.173,  = 0.006) respectively. Kaplan-Meier estimates showed a lower chance of cardiomyopathy-free survival for QTc ≥ 440 ms and ΣQRS(6 L) ≤ 3.2 mV over time. After controlling for confounders, total anthracycline dose predicted a decrease in ΣQRS(6 L) and an increase in QTc independent of cardiomyopathy status ( = 0.01 and  < 0.001 respectively). Cardiotoxic radiation did not predict changes in ECG parameters. Cardiomyopathy was associated with increased mortality (34% versus 12%,  < 0.001).

Conclusion: In children receiving anthracyclines, decrease in ΣQRS(6 L) and QTc prolongation are associated with increased risk of developing cardiomyopathy. ECG is a potential non-invasive risk stratification tool for prediction of anthracycline-induced cardiomyopathy and requires prospective validation.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048097PMC
http://dx.doi.org/10.1186/s40959-019-0045-6DOI Listing

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