Utility of research of cardiac biomarkers for early diagnosis of anthracycline induced cardiotoxicity in children

Introduction: Cytostatic treatment in malignant diseases in child and adult, and especially those with anthracyclines, is associated with adverse events of cardiotoxicity that may worsen the prognosis of patients. Early diagnosis of cardiotoxicity can allow us to institute measures for prevention or reduction of these severe events. Cardiac biomarkers research in children treated with anthracyclines may be useful for the early diagnosis of anthracycline induced cardiotoxicity and for monitoring its evolution. Objective: To establish the value of research of cardiac biomarkers for early diagnosis of anthracycline induced cardiotoxicity in children with malignant hemopathies. Methods: The authors followed 46 children (aged 2 months – 18 years), treated for malignant hemopathies with anthracyclines  various manifestations of cardiotoxicity Control group was composed of 20 healthy children without history of cardiac diseases. Patients and controls were investigated by: • clinical exam, Doppler echocardiography (Echo); • determination of plasma values of cardiac biomarkers: BNP (B natriuretic peptide) and cTnI (troponin). Results: Clinical exam: signs of heart failure (6 cases), heart murmurs and often without signs of cardiac involvement. Determination of cardiac biomarkers showed: * increased plasma levels of BNP in 45.7% of patients, from a mean baseline of 89 ng/ml (0 – 117 ng/ ml) to 240 ng/ml (0 – 810 ng/ml); * increasing cTnI values of plasma at 4.34% of cases (initial values < 0.04 pg/ml to values > 0.04 pg/ml). Echo modifications: anthracycline induced cardiomyopathy or just only diastolic dysfunction of LV in majority of cases. Biomarkers changes were correlated in most cases with the presence of clinical manifestations and echo mentioned modifications. Conclusions: Increased levels of cardiac biomarkers: BNP and cTnI in children with malignancies treated with anthracycline are positively correlated with installation of the anthracyclines induced cardiotoxicity, with clinical or infraclinical manifestations. Changes in these parameters, which may represent a marker, appeared earlier than echo modifications in anthracycline induced cardiotoxicity and it is necessary to systematically monitor these parameters during and after cytostatic therapy, even in the time of initiation of this therapy.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)