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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 10, p. 981 - 988 |
Diagnostic Possibilities of Late Sequelae
of Chemotherapy with Anthracyclines Elbl L.1, Hrstková H.2,Chaloupka V.1, Novotný J.3 1Oddělení funkčního vyšetřování FN Brno, pracoviště Bohunice, přednosta doc.MUDr. Václav Chaloupka, CSc. 2I. dětská interní klinika FN Brno, pracoviště Fakultní dětská nemocnice J. G. Mendela, přednostka doc. MUDr. Hana Hrstková, CSc. 3Fakulta sportovních studií Masarykovy univerzity, Brno, přednosta doc. PhDr. Michal Charvát, CSc. |
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Summary: Anthracyclines areamong the most frequently used cytostatics in the treatment of haematological
malignities and some solid tumours in childhood and adult age. They affect cellular proliferation
in several ways. One of them is the formation of semiquinone radicals which form with oxygen
toxic peroxides which damage the myocyte and lead to cardiotoxicity. Cardiotoxicity of anthracyclines
has become a clinical problem as it restricts the administered dose of the cytostatic and
has become particularly urgent after discovery of the late toxicity which appears some years after
termination of anti-tumourous treatment. Damage of the left ventricle is usually characterized by
partial reversible contractile dysfunction (early damage) or progressing contractile dysfunction
(late damage). The diagnosis of cardiotoxicity is important during the period of treatment but in
particular after completed chemotherapy. The application of diagnostic methods before and in
the course of chemotherapy is indicated when large doses of anthracyclines will be administered
or when in the patient risk factors cumulate or if he developed signs of cardiotoxicity. The use of
diagnostic methods after termination of treatment is valuable for early detection of late cardiotoxicity
for timing of further diagnostic methods currently used in cardiology. In the routine diagnosis
the authors prefer follow up of the left ventricle by assessment of the ejection fraction by
echocardiography or by radionuclide examination. In paediatrics we follow up indicators of systolic
left ventricular function in relation to changes of the after load. The authors present also
a review of other diagnostic methods and procedures which may prove useful in the diagnosis of
cardiotoxicity of anthracyclines.
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