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Is screening for abnormal ECG patterns justified in long-term follow-up of childhood cancer survivors treated with anthracyclines?

Authors :
Pourier, M.S.
Mavinkurve-Groothuis, A.M.C.
Loonen, J.J.
Bokkerink, J.P.M.
Roeleveld, N.
Beer, G.
Bellersen, L.
Kapusta, L.
Pourier, M.S.
Mavinkurve-Groothuis, A.M.C.
Loonen, J.J.
Bokkerink, J.P.M.
Roeleveld, N.
Beer, G.
Bellersen, L.
Kapusta, L.
Source :
Pediatric Blood & Cancer; 1545-5009; 3; 64; UNSP e26243; ~Pediatric Blood & Cancer~~~~~1545-5009~3~64~~UNSP e26243
Publication Year :
2017

Abstract

Contains fulltext : 169726.pdf (publisher's version ) (Closed access)<br />BACKGROUND: ECG and echocardiography are noninvasive screening tools to detect subclinical cardiotoxicity in childhood cancer survivors (CCSs). Our aims were as follows: (1) assess the prevalence of abnormal ECG patterns, (2) determine the agreement between abnormal ECG patterns and echocardiographic abnormalities; and (3) determine whether ECG screening for subclinical cardiotoxicity in CCSs is justified. PROCEDURE: We retrospectively studied ECG and echocardiography in asymptomatic CCSs more than 5 years after anthracycline treatment. Exclusion criteria were abnormal ECG and/or echocardiogram at the start of therapy, incomplete follow-up data, clinical heart failure, cardiac medication, and congenital heart disease. ECG abnormalities were classified using the Minnesota Code. Level of agreement between ECG and echocardiography was calculated with Cohen kappa. RESULTS: We included 340 survivors with a mean follow-up of 14.5 years (range 5-32). ECG was abnormal in 73 survivors (21.5%), with ventricular conduction disorders, sinus bradycardia, and high-amplitude R waves being most common. Prolonged QTc (>0.45 msec) was found in two survivors, both with a cumulative anthracycline dose of 300 mg/m2 or higher. Echocardiography showed abnormalities in 44 survivors (12.9%), mostly mild valvular abnormalities. The level of agreement between ECG and echocardiography was low (kappa 0.09). Male survivors more often had an abnormal ECG (corrected odds ratio: 3.00, 95% confidence interval: 1.68-5.37). CONCLUSIONS: Abnormal ECG patterns were present in 21% of asymptomatic long-term CCSs. Lack of agreement between abnormal ECG patterns and echocardiographic abnormalities may suggest that ECG is valuable in long-term follow-up of CCSs. However, it is not clear whether these abnormal ECG patterns will be clinically relevant.

Details

Database :
OAIster
Journal :
Pediatric Blood & Cancer; 1545-5009; 3; 64; UNSP e26243; ~Pediatric Blood & Cancer~~~~~1545-5009~3~64~~UNSP e26243
Publication Type :
Electronic Resource
Accession number :
edsoai.on1284168567
Document Type :
Electronic Resource