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.研究目标：本研究旨在明确巴基斯坦三级医疗中心内，16岁以下罹患儿童恶性肿瘤的患儿中，蒽环类药物（anthracycline）诱导的急性（1个月内）及早发性慢性进行性（1年内）心脏毒性情况。 研究设计：前瞻性队列研究。 研究地点：巴基斯坦卡拉奇阿迦汗大学。 研究对象：110名年龄介于1个月至16岁的儿童。 干预措施：蒽环类药物（多柔比星(Doxorubicin)和/或柔红霉素(Daunorubicin)）。 结局测量：对2010年7月至2012年6月期间接受蒽环类药物化疗，并完成基线、1个月及1年共3次超声心动图（echocardiographic）评估的所有患儿，前瞻性分析其心功能不全发生情况；采用重复测量方差分析（repeated measures analysis of variance, r-ANOVA）对基线、1个月及1年时的收缩与舒张心功能进行统计学分析。 结果：受试者平均年龄为74±44个月，其中男性75例（占比68.2%）。70例（64%）患者为急性淋巴细胞白血病（acute lymphoblastic leukemia, ALL）。59例（54%）仅接受多柔比星单药治疗，35例（32%）采用联合化疗方案。95例（86%）患儿的蒽环类药物累积剂量<300mg/m²。15例（14%）患儿在治疗后1个月内出现心功能不全，28例（25%）患儿在1年内出现心功能不全。其中分别有10/15（66.6%）和12/28（42%）为孤立性舒张功能不全，5/15（33.3%）和16/28（57%）为收缩与舒张联合功能不全。7例（6.4%）患者因严重心功能不全死亡。59例接受多柔比星单药治疗的患儿中，8例（13.5%）出现心功能不全，且该情况多与较高的累积剂量相关（p<0.001）。采用多柔比星联合柔红霉素治疗的患儿心脏毒性发生率更高（p=0.004）。 结论：蒽环类药物诱导的心功能不全发生率较高。对于接受任何剂量蒽环类药物治疗的儿童，长期随访至关重要，因其临床表现可延迟出现。