COMPLEX MONITORING OF CARDIOTOXICITY IN HEMATOONCOLOGY

Aim: Monitoring of cardiotoxicity of anthracyclines (ANT) with 3 diagnostic methods: biochemical markers – N-terminal pro brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT); echocardiography (ECHO) and electrocardiography (ECG).
Patients and methods: 26 adult acute leukemia patients (mean age 46.2±12.4 years, 15 males and 11 females) treated with 2–6 cycles of ANT-based chemotherapy (CT) were studied. Cardiac evaluation was performed at the baseline (before CT), after first CT (cumulative ANT dose 136.3±28.3 mg/m2), after last CT (cumulative ANT dose 464.3±117.5 mg/m2) and circa 6 months after completion of CT (6 Mo after CT).
Results: The results are summarized in the Table. Six months after CT, NT-proBNP concentrations correlated with systolic and diastolic LV dysfunction on ECHO – (r=0.514; p<0.01) and (r=0.587; p<0.01). Decreased QRS voltage on ECG correlated with systolic and diastolic LV dysfunction on ECHO – (r=0.660; p<0.001) and (r=0.592; p<0.01).
Conclusions: Our results demonstrate acute and chronic cardiotoxicity of ANT. Clinical manifestation of cardiotoxicity in terms of heart failure developed in 2 (7.7 %) patients. In asymptomatic patients, abnormal cardiac findings (NT-proBNP elevations, diastolic LV dysfunction, QTc prolongation) represent subclinical cardiotoxicity, which indicates a risk for development of heart failure and malignant ventricular arrhythmias. In regard of late ANT cardiotoxicity, further cardiology follow-up is warranted in all acute leukemia survivors.
Supported by Research Project MO 0FVZ 0000 503.