Data from: Anthracycline induced cardiotoxicity: prospective cohort study from Pakistan.

Objectives: To identify anthracycline induced acute (within one month) and
early onset chronic progressive (within year) cardiotoxicity in children
younger than 16 years of age with childhood malignancies at tertiary care
center of Pakistan. Design: Prospective Cohort study. Setting: Aga Khan
University, Karachi, Pakistan. Participants: 110 children (aged 1 month to
16 years). Intervention: Anthracycline (Doxorubicin and/or Daunorubicin).
Outcome measurements: All children who received anthracycline as
chemotherapy and three echocardiographic evaluations (baseline, one month
and 1 year) between July 2010 and June 2012 were prospectively analyzed
for cardiac dysfunction. Statistical analysis including systolic and
diastolic functions at baseline, 1 month and 1 year were made by repeated
measures analysis of variance (r-ANOVA). Results: Mean age was 74±44
months and 75 (68.2%) were males. Acute lymphoblastic leukemia (ALL) was
seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and
combination therapy was used in 35(32%). A cumulative dose of
anthracycline <300mg/m2 was in 95 (86%). Fifteen (14%) children
developed cardiac dysfunction within a month and 28(25%) children within a
year. Of these 10/15 (66.6%) and 12/28 (42%) had isolated diastolic
dysfunction respectively, while 5/15 (33.3%) and 16/28 (57%) had combined
systolic and diastolic dysfunction. Seven (6.4%) patients expired due to
severe cardiac dysfunction. 8/59 (13.5%) children receiving doxorubicin
showed dysfunction mostly related to higher cumulative dose
(p=<0.001). Cardiotoxicity was high where combination of
doxorubicin and daunorubicin was used (p=0.004). Conclusion: Anthracycline
induced cardiac dysfunction is high. Long term follow-up is essential in
children received any dosage of anthracyclines because of its late
manifestation.