Antrasiklinlerle Tedavi Edilmiş Pediatrik Kanser Hastalarında Uzun Dönemde Gelişen Subklinik Kardiyotoksisitenin Fonksiyonel Egzersiz Kapasitesi Üzerine Etkisi

Abstract

Amaç: Çalışmada antrasiklin kullanılarak tedavi edilmiş pediatrik kanser hastalarının uzun dönem takiplerinde görülebilen subklinik kardiyotoksisite ile fonksiyonel egzersiz kapasitesi arasındaki ilişki incelenmiştir.Gereç ve Yöntemler: Kemoterapi tedavisi 9-16 yıl önce tamamlanmış ve kalp yetmezliği bulguları olmayan 16 hasta ile 16 sağlıklı kontrol çalışmaya alındı. Ejeksiyon fraksiyonu, fraksiyonel kısalma ve miyokardiyal performans indeksi ölçümleri ekokardiyografik olarak alındı. Subklinik kardiyotoksisite açısından miyokardiyal performans indeks sınırı 0.37 olarak kabul edildi. Fonksiyonel egzersiz kapasitesi 6-dakika yürüme testi ile değerlendirildi.Bulgular: Hastaların miyokardiyal performans indeks değerleri belirgin olarak kontrol grubundan daha yüksek saptandı (p<0.001). 6-dakika yürüme testi mesafesi kontrol grubuna göre hastalarda daha kısa ölçüldü (p= 0.02); özellikle subklinik kardiyotoksisitesi olan hastalarda bu fark daha belirgindi (p= 0.001). 6-dakika yürüme testi ile miyokardiyal performans indeksi arasında iyi bir korelasyon bulunduğu gibi (r= -0.6 p=0.03) kümülatif antrasiklin dozu ile bu iki değer arasında da anlamlı korelasyon saptandı (sırasıyla r= -0.6 p= 0.04 ve r= 0.6 p= 0.02).Sonuç: Tedavisi tamamlanmış pediatrik kanser hastalarının uzun dönem takiplerinde klinik bulgu olmaksızın subklinik kardiyotoksisite görülebilmektedir. Fonksiyonel egzersiz kapasitesinin ve bunun sonucunda yaşam kalitesinin düşmesiyle sonuçlanabileceğinden subklinik kardiyotoksisite önemsenmesi gereken bir durumdur. 6-dakika yürüme testi ve miyokardiyal performans indeksi arasında iyi bir korelasyon olduğundan subklinik kardiyotoksisite açısından bir belirleyici olarak kullanılabilir.

Keywords

• Günlük aktiviteler, Antrasiklinler, Kanser, Çocuklar, Hayat kalitesi

Effect of Late-Term Subclinical Cardiotoxicity on Functional Exercise Capacity of Pediatric Cancer Survivors who were Treated with Anthracyclines

Abstract

Objective: We aimed to evaluate the functional exercise capacity and its relation to echocardiographic measurements in pediatric cancer survivors who were treated with anthracyclines.Material and Methods: Sixteen patients who completed chemotherapy 9-16 years ago and who have no symptoms of heart failure were enrolled in the study, together with 16 healthy subjects. Ejection fraction, fractional shortening, and myocardial performance index were calculated by echocardiographic evaluation. Patients with a myocardial performance index > 0.37 were accepted as having subclinical cardiotoxicity. Functional exercise capacity was evaluated by the sixminute walk test. results: Patients had significantly higher values of myocardial performance index than control subjects (p < 0.001). The six-minute walking distance was found to be lower in patients than that of the control subjects (p= 0.02). Furthermore, in patients with subclinical cardiotoxicity, the difference was more significant (p= 0.001). Six minute walking distance and myocardial performance index were well correlated with each other (r= -0.6 p= 0.03) and with cumulative anthracycline dosage (r= -0.6 p= 0.04 and r= 0.6 p= 0.02 respectively).conclusion: Long-term pediatric cancer survivors may have subclinicalcardiotoxicity despite having no clinical symptoms. Patients with subclinical cardiotoxicity should be taken into account for having impaired functional exercise capacity and correspondingly low quality of life. Six-minute walk test could be a useful indicator for subclinical cardiotoxicity since it is well correlated with myocardial performance index

Keywords

• Activities of daily living, Anthracycline, Cancer, Children, Quality of life

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