Assessment of late anthracycline-induced cardiotoxicity by 123 I- m IBG cardiac scintigraphy in patients treated during childhood and adolescence

The goal of this study was to evaluate late cardiotoxic effects of anthracyclines (atc) by evaluating cardiac sympathetic activity in a cohort of asymptomatic patients previously treated with atc for childhood cancers. we studied 89 asymptomatic patients previously treated with atc with a normal echocardiogram (49 men and 40 women) and a control group of 40 healthy individuals (26 men and 14 women). both groups underwent planar myocardial 123i-meta-iodobenzylguanidine scintigraphy (123i-mibg). from these images, the early and late heart-to-mediastinum (h/m) ratio and washout rate (wr) were assessed. the mean survival at the time of the 123i-mibg scintigraphy was 5.3 ± 3.4 years. patients treated with atc had a lower but clinical normal left ventricular ejection fraction (lvef) compared to controls (60.44 ± 6.5 vs 64.1 ± 6.0%, p < 0.01). both the late h/m ratio and wr were not able to discriminate atc treated patients from controls. the cumulative atc dose was the only independent predictor of the lvef, explaining approximately 12% of the variation in lvef (p = 0.01). although the pathophysiology behind atc cardiotoxicity is most likely multifactorial, myocardial sympathetic activity is not associated with a reduction in lvef 5-years after completion of chemotherapy.