Early myocardial injury in children on cancer chemotherapy
Abstract
BACKGROUND: Use of chemotherapeutic agents has been associated with cardiac
toxicities. Detection of early cardiac toxicities of cancer chemotherapy is essential so as
to prevent occurrence of late cardiac toxicities. Cardiac troponins have been shown to
detect subclinical injury much earlier than echocardiography.
OBJECTIVE: To determine the prevalence and associated factors of myocardial injury
as determined by elevated cardiac troponin T (cTnT), in children on cancer chemotherapy
at Kenyatta National hospital(KNH).
METHODOLOGY: A hospital based cross-sectional study in children aged 1 month to
18 years who had a diagnosis of cancer and were admitted to KNH. The patients
underwent Echocardiography (ECHO) before their scheduled chemotherapy infusion.
Twenty four (24) hours after the chemotherapy infusion the patients had an evaluation of
the serum cardiac troponin T (CTnT) and a repeat echocardiography (ECHO).
Myocardial injury was defined as cTnT level greater than 0.014 ng/ml or a Fractional
shortening of <29% respectively on ECHO.
STUDY RESULTS: One hundred (100) children were included in the final analysis.
Thirty-two percent (32%) of the study population had an elevated cTnT. A cumulative
Adriamycin dose of >175mg/m2 was significantly associated with and elevated cTnT OR
10.76 (95% CI 1.18-97.92) p=0.035. Diagnosis of Nephroblastoma was also significantly
associated with an elevated cTnT OR 3 (95% CI 1.23-7.26) p=0.015. Nine percent (9%)
of the participants had echocardiographic evidence of myocardial injury. There was no
association between elevated cTnT and a reduced fractional shortening.
CONCLUSION: Thirty two percent of the study population had myocardial injury as
determined by an elevated cTnT and 9% had echocardiographic evidence of myocardial
injury.
RECOMMENDATION: CTnT should be considered as a screening test for myocardial
injury in children on cancer chemotherapy.
Publisher
University of Nairobi
Subject
Early Myocardial InjuryRights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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