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.