Avtor/Urednik		Velenšek-Prestor, Veronika; Rakovec, Peter; Koželj, Mirta; Jereb, Berta; Kržišnik, Ciril
Naslov		Pomen sledenja srčne funkcije pri mladostnikih, zdravljenih z antraciklini zaradi raka v otroštvu
Prevedeni naslov		Importance of follow up of cardiac function after treatment with anthracyclines for cancer in childhood
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 69, št. 7-8
Leto izdaje		2000
Obseg		str. 499-504
Jezik		slo
Abstrakt		Background. In a a retrospecrive study the influence of antracyclines therapy and of the risk factors was analysed. The aim of our study was further to define the most sutiable method for detection late cardiac toxicity caused by antracyclines. Methods. Fourty-sixpatients, 2-17years old at diagnosis were included. The time of follow up was 5-23 years. Thirty-four patients received a cumulative dosis of antracycline (AC) between 50 and 540 mg/m2 (mean 203 mg/m2) and I2 were not treated with AC (control group). The methods of evaluation of cardiac performance included: clinical history, physical examination, electrocardiogram (ECG), ECG exercise testing on a bicycle ergometer and echocardiography. For statistical analysis the Chi2 test and the T test were used. Results. Exercise tolerance was below the predicted values in 23 (50%) of all patients. In 21 (46%) patients ECG abnormalities were found. Treatment with AC influenced the ECG exercise testing. Seven patients (19%) had mitral insufficiency; the concomitant treatment with AC and alkylating agents correlated with mitral insufficiency. The concomitant treatmenth with AC and alkylating agens was also correlated with prolonged isovolumic relaxation time (IVRT) and influenced significantly the volume of the left atrium (p = 0.02). Sixteen ( 52%) survivors had IVRT 90 = ms. There were no significant diferences in other parameters of diastolic or systolic function. Conclusions. In survivors treated with anthracyclines abnormalities of the cardiac function are more frequent than in those who had no anthracycline therapy, mainly manifested as abnormal diastolic function. Close follow up of survivors of anthracyclines therapy is necessary; it allows identification of subclinical carditoxicity.
Izvleček		Izhodišča. V retrospektivni raziskavi smo ugotovljali pozne posledice zdravljenja z antraciklini (AC) in vpliv različnih dejavnikov na pojav kardiotoksičnosti. Hkrati smo skušali najti najzanesljivejšo metodo za zgodnje odkrivanje pozne toksičnosti AC. Metode. Vključili smo 46 preiskovancev, zdravljenih zaradi levkemije, v starosti 2-17 let, zdaj 5-23 let po končanem zdravljenju. 34 mladostnikov je dobivalo antracikline (50 do 540 mg/m2), 12 pa ne (kontrolna skupina). Preiskovalne metode so vključevale anamnezo, fizikalni pregled, EKG, obremenitveno testiranje in ehokardiografijo. Za statistično analizo smo uporabili Hi2 test in T test za neodvisne vzorce. Rezultati. 23 mladostnikov (50%) je doseglo nižjo delovno obremenitev od pričakovane. Pri 21 (46%) smo ugotovili spremembe na EKG-ju (mirovanje ali obremenitev). Zdravljenje z AC je nekoliko vplivalo na izvid EKG med obremenitvijo. Sedem mladostnikov (19%) je imelo mitralno insuficienco, zdravljenje z AC in alkilirajočimi sredstvi je nekoliko vplivalo na mitralno insuficienco. Zdravljenje z AC ter sočasno zdravljenje z AC in alkilirajočimi sredstvi je nakazano vplivalo na podaljšanje časa izovolumetrične relaksacije (IVRT) in statistično značilno na velikost levega preddvora (P=0,02). 16 mladostnikov (52%) je imelo IVRT daljši od 90 ms. V ostalih kazalnikih diastolične funkcije in v sistolični funkciji nismo ugotovili pomembnejše razlike med skupinama. Zaključki. Tudi manjši skupni odmerki AC povzročajo spremembe v delovanju srca, predvsem motnje v diastoli. Vse mladostnike, zdravljenje z antraciklini, je treba slediti, saj je pomembno, da okvaro srca odkrijemo in opredelimo, še preden nastopijo klinični znaki antraciklinske kardiomiopatije in srčnega popuščanja.
Deskriptorji		LEUKEMIA ANTHRACYCLINES HEART DISEASES CHILD ADOLESCENCE MEDICAL HISTORY TAKING PHYSICAL EXAMINATION ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY RETROSPECTIVE STUDIES