Ecocardiografia durante sforzo isometrico in pazienti sopravvissuti a lungo termine ad una neoplasis dell'infanzia, trattati con radio e chemioterapia

To disclose late cardiac sequelae in asymptomatic patients treated with anthracycline and mediastinal radiotherapy an echo-stress screening test was used. Seventy-four patients (mean age 19 ± 4 years) and 13 normal age-matched control subjects underwent echocardiographic examination during isometric handgrip exercise. The patients were treated from 1 to 13 years (mean 6.9 ± 3.3 years) before the examination with 90-450 mg/m² of doxorubicin (mean 241 ± 103 mg/m²) and 49 of them (66%) also received 24-38 Gy of radiotherapy (29-5 Gy) to a field including the heart. The major findings at rest, in the patients compared with controls, were a reduced left ventricular posterior wall thickness (1.22 ± 0.17 vs 1.36 ± 0.15 cm; p = 0.007) and a slightly lower fractional shortening (32.8 ± 4.4 vs 35.3 ± 3.4%; p = 0.06). During handgrip exercise left ventricular end-systolic wall thickness (posterior wall plus septal dimensions divided by two) adjusted for body surface area was decreased (0.75 ± 0.12 vs 0.83 ± 0.06 cm/m²; p = 0.02), end-systolic wall stress was much higher (90.2 ± 23.8 vs 69.9 ± 12.4 g/cm²; p = 0.004) and fractional shortening became more significantly reduced (32.7 ± 4.8 vs 38 ± 5%; p = 0.0001) in the patients compared with controls. No differences were found in blood pressure or heart rate both at rest and during exercise between the two groups. These results suggest that asymptomatic long-term survivors of childhood cancer treated with doxorubicin and mediastinal radiotherapy may have subtle abnormalities in cardiac performance which become more clearly delineated after isometric handgrip exercise.