Introduction: Cardiotoxicity is a known complication of anthracyclines’ therapy in children treated for malignancies. Regular monitoring of cardiac function enables the identification of heart damage at subclinical level and timely therapeutic intervention. (1, 2) The scope of our study was to show the results of a multiannual echocardiographic follow-up of patients treated with anthracycline chemotherapeutic agents in our institution.

Patients and Methods: We retrospectively analyzed a data obtained by echocardiographic monitoring of patients treated for malignant diseases in the Department of Oncology and Hematology, Children’s Hospital Zagreb from 2003 to 2016. The systolic function of the left ventricle was observed through shortening fraction (FS), while the diastolic function was studied through early (E) and late (A) ventricular filling velocities, their ratio (E/A) and the dimensions of the left ventricle correlated with age, gender and the anthracycline dose.

Results: Overall 378 children were included in the study (average age 8.8 years (+7.36), 234 male (62%). From those patients most of them had a diagnosis of sarcoma, while hematologic malignancies were the second most prevalent diagnosis. The total cumulative dose of anthracycline was <100 mg/m² in 67 (20%) patients, 207 (61%) patients received a dose of 101-300 mg/m², and 66 (19%) patients received a dose higher than 301 mg/m². None of the patients had clinical signs of heart failure, however 18% of children had subclinical heart damage, of whom 13.8% during the chemotherapy and within 6 months of its completion, and in 4.2% of patients the damage was still present or observed 6 months after the end of the chemotherapeutic treatment. There was a clear correlation between reduced systolic function and the anthracycline cumulative dose (p <0.01). Diastolic dysfunction was registered in 5% of patients, but no correlation was found with the cumulative anthracycline dose. A total of 55 (14.5%) children received cardiac pharmacotherapy, ACE inhibitors and/or beta-blockers.

Conclusion: Subclinical damage of the systolic cardiac function in children treated for malignant diseases was present in a significant percentage and correlated with the cumulative dose of anthracyclines, despite the normal cardiac status, which requires regular cardiac monitoring of these patients.