Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring

Dilek, Fatih; Dindar, Aygün; Bilge, Ahmet; Nişli, Kemal; Eker Ömeroğlu, Rukiye

doi:https://dx.doi.org/10.5222/j.child.2018.38278

Research Article

DOI :10.5222/j.child.2018.38278 IUP :10.5222/j.child.2018.38278 Full Text (PDF)

Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring

Fatih Dilek, Aygün Dindar, Ahmet Kaya Bilge, Kemal Nişli, Rukiye Eker Ömeroğlu

Objection: Anthracyclines are chemotherapeutics that are widely used in childhood malignancies. However, these effective drugs can cause acute and chronic cardiotoxicity. In this study, we aimed to investigate acute anthracycline cardiotoxicity using heart rate variability (HRV) analysis and 24-hour Holter monitoring methods. Material and Method: Fifteen children with acute lymphoblastic leukemia underwent 24-hour Holter monitoring on the day before the anthracycline treatment and during the day of anthracycline infusion. Fifteen healthy children were included in the control group and this group underwent 24- hour Holter monitoring only once. HRV parameters were calculated separately for night and day time and observed arrhythmias were assessed on an hourly basis. Results: In pre-treatment records of the patient group; average cycle time (NN), rate of adjacent NN intervals count differing by more than 50 millisecond to total NN intervals count (pNN50) and power in the high frequency range (HF) / power in the low frequency range (LF) ratios during the night were significantly lower than healthy controls. In addition, on the day of anthracycline treatment HF / LF ratio during the night was significantly lower compared to the control group. According to the results of the Holter monitorization; the number of supraventricular and ventricular ectopic beats were significantly increased compared to the control group on the day of anthracycline treatment. Besides, number of ventricular ectopic beats in patients increased significantly during anthracycline infusion, and ventricular tachycardia was detected in 20% of patients. Conclusion: Our results are consistent with the results of the HRV analysis studies conducted on chronic anthracycline cardiotoxicity. However, further studies are needed in this regard. Anthracycline infusion may trigger serious arrhythmias, so we believe that it would be beneficial to perform cardiac monitoring at least during infusion of the drug.

Keywords: Anthracycline, cardiotoxicity, heart rate variability, holter, arrythmia

DOI :10.5222/j.child.2018.38278 IUP :10.5222/j.child.2018.38278 Full Text (PDF)

Akut Antrasiklin Kardiyotoksisitesinin Kalp Hızı Değişkenliği Analizi ve 24 Saatlik Holter Monitorizasyonu ile İncelenmesi

Fatih Dilek, Aygün Dindar, Ahmet Kaya Bilge, Kemal Nişli, Rukiye Eker Ömeroğlu

Amaç: Antrasiklinler çocukluk çağının birçok malignitesinde yaygın olarak kullanılan kemoterapötiklerdir. Fakat bu etkili ilaçlar akut ve kronik kardiyotoksisiteye neden olabilmektedirler. Biz bu çalışmada, akut antrasiklin kardiyotoksisitesini kalp hızı değişkenliği (KHD) analizi ve 24 saat holter monitorizasyonu yöntemleri ile araştırmayı amaçladık. Gereç ve Yöntem: On beş akut lenfoblastik lösemi tanılı çocuğa antrasiklin tedavisi alacakları gün öncesinde ve antrasiklin infüzyonu aldıkları gün 24 saatlik holter monitorizasyonu uygulandı. On beş sağlıklı çocuk kontrol grubuna dâhil edildi ve bu gruba da bir kez 24 saatlik holter monitorizasyonu uygulandı. KHD’nin parametreleri gece ve gündüz saatleri için ayrı ayrı hesaplandı ve izlenen aritmiler saatlik olarak değerlendirildi. Bulgular: Hasta grubunun tedavi öncesi kayıtlarında; gece saatlerinde ortalama siklüs süresi (NN), iki NN intervali arasında 50 milisaniyeden fazla değişim gösterenlerin sayısının toplam NN intervali sayısına oranı (pNN50) ve yüksek frekans alanındaki güç (HF) / düşük frekans alanındaki güç (LF) oranlarının sağlıklı kontrollere göre anlamlı olarak düşük olduğunu saptadık. Tedavi alınan günün gece kayıtlarında HF/LF oranı kontrol grubuna göre anlamlı olarak düşüktü. Holter monitorizasyonu sonuçlarında ise tedavi alınan günde supraventriküler ve ventriküler ektopi sayılarının kontrol grubuna göre anlamlı olarak arttığı saptandı. Ayrıca antrasiklin infüzyonu sırasında hastaların ventriküler ektopi sayıları anlamlı oranda yükseldi ve hastaların %20’sinde ventriküler taşikardi atağı izlendi. Sonuç: KHD analizi sonuçlarımız kronik antrasiklin kardiyotoksisitesi üzerine yapılan çalışmaların sonuçları ile uyumludur. Fakat bu konuda daha ileri çalışmalara gereksinim vardır. Antrasiklin infüzyonu ciddi aritmileri tetikleyebilir, bu yüzden en azından ilacın infüzyonu sırasında kardiyak monitorizasyon uygulanmasının yararlı olacağı düşüncesindeyiz.

Keywords: Antrasiklin, kardiyotoksisite, kalp hızı değişkenliği, holter, aritmi

References

1. Asselin BL. Epidemiology of Childhood and Adolescent Cancer. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics 20th ed. Elsevier Inc, 2016: 2416-8. google scholar
2. van Dalen EC, Caron HN, Kremer LCM. Prevention of anthracycline-induced cardiotoxicity in children: The evidence. Eur J Cancer 2007;43(7):1134-40. https://doi.org/10.1016/j.ejca.2007.01.040 google scholar
3. Tan TC, Neilan TG, Francis S, Plana JC, ScherrerCrosbie M. Anthracycline-induced cardiomyopathy in adults. Compr Physiol. 2015;5(3):1517-40. https://doi.org/10.1002/cphy.c140059 google scholar
4. Bansal N, Amdani S, Lipshultz ER, Lipshultz SE. Chemotherapy-induced cardiotoxicity in children. Expert Opin Drug Metab Toxicol. 2017;13(8):817–32. https://doi.org/10.1080/17425255.2017.1351547 google scholar
5. Krischer JP, Epstein S, Cuthbertson DD, Goorin AM, Epstein ML, Lipshultz SE. Clinical cardiotoxicity following anthracycline treatment for childhood cancer: the Pediatric Oncology Group experience. J Clin Oncol. 1997;15(4):1544-52. https://doi.org/10.1200/JCO.1997.15.4.1544 google scholar
6. Pai VB, Nahata MC. Cardiotoxicity of chemotherapeutic agents: incidence, treatment and prevention. Drug Saf. 2000;22(4):263-302. https://doi.org/10.2165/00002018-200022040-00002 google scholar
7. van Dalen EC, van der Pal HJH, Kok WEM, Caron HN, Kremer LCM. Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study. Eur J Cancer 2006;42(18):3191-8. https://doi.org/10.1016/j.ejca.2006.08.005 google scholar
8. Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. Heart Rate Variability Standards of Measurement, Physiological Interpretation, and Clinical Use. (accessed, January 9, at http://circ.ahajournals.org/content/ 93/5/1043.long) google scholar
9. Meinardi MT, van der Graaf WT, van Veldhuisen DJ, Gietema JA, de Vries EG, Sleijfer DT. Detection of anthracycline-induced cardiotoxicity. Cancer Treat Rev. 1999;25(4):237-47. https://doi.org/10.1053/ctrv.1999.0128 google scholar
10. Tjeerdsma G, Meinardi MT, van Der Graaf WT, van Den Berg MP, Mulder NH, Crijns HJ, et al. Early detection of anthracycline induced cardiotoxicity in asymptomatic patients with normal left ventricular systolic function: autonomic versus echocardiographic variables. Heart 1999;81(4):419-23. https://doi.org/10.1136/hrt.81.4.419 google scholar
11. Postma A, Bink-Boelkens MTE, Beaufort-Krol GCM, Kengen RAM, Elzenga NJ, Schasfoort-van Leeuwen MJM, et al. Late cardiotoxicity after treatment for a malignant bone tumor. Med Pediatr Oncol. 1996;26(4): 230-7. https://doi.org/10.1002/(SICI)1096-911X(199604) 26:43.0.CO;2-K google scholar
12. Kamath M V, Halton J, Harvey A, Turner-Gomes S, McArthur A, Barr RD. Cardiac autonomic dysfunction in survivors of acute lymphoblastic leukemia in childhood. Int J Oncol. 1998;12(3):635-40. https://doi.org/10.3892/ijo.12.3.635 google scholar
13. Nousiainen T, Vanninen E, Jantunen E, Remes J, Ritanen E, Vuolteenaho O, et al. Neuroendocrine changes during the evolution of doxorubicin-induced left ventricular dysfunction in adult lymphoma patients. Clin Sci (Lond) 2001;101(6):601-7. https://doi.org/10.1042/cs1010601 google scholar
14. Potočnik N, Perš E M, Cerar A, Injac R, Arko Finderle Ž. Cardiac autonomic modulation induced by doxorubicin in a rodent model of colorectal cancer and the influence of fullerenol pretreatment. (Accesed January 8, at https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5519181/pdf/pone.0181632.pdf) google scholar
15. Lončar-Turukalo T, Vasić M, Tasić T, Mijatović G, Glumac S, Bajić D, et al. Heart rate dynamics in doxorubicin-induced cardiomyopathy. Physiol Meas 2015;36(4):727-39. https://doi.org/10.1088/0967-3334/36/4/727 google scholar
16. Steinberg JS, Cohen AJ, Wasserman AG, Cohen P, Ross AM. Acute arrhythmogenicity of doxorubicin administration. Cancer. 1987;60(6):1213-8. https://doi.org/10.1002/1097-0142(19870915)60: 63.0.CO;2-V Çocuk Dergisi 2018;18(1):29-38 38 google scholar
17. Markman TM, Nazarian S. Arrhythmia and electrophysiological effects of chemotherapy: A Review. Oncol. 2016;91(2):61-8. https://doi.org/10.1159/000446374 google scholar
18. Kilickap S, Barista I, Akgul E, Aytemir K, Aksoy S, Tekuzman G. Early and late arrhythmogenic effects of doxorubicin. South Med J. 2007;100(3):262-5. https://doi.org/10.1097/01.smj.0000257382.89910.fe google scholar
19. Tamargo J, Caballero R, Delpón E. Cancer chemotherapy and cardiac arrhythmias: a review. Drug Saf. 2015;38(2):129-52. https://doi.org/10.1007/s40264-014-0258-4 google scholar
20. Massin MM, Dresse MF, Schmitz V, Hoyoux C, Chantraine JM, Lepage P. Acute arrhythmogenicity of first-dose chemotherapeutic agents in children. Med Pediatr Oncol. 2002;39(2):93-8. https://doi.org/10.1002/mpo.10123 google scholar

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APA

Dilek, F., Dindar, A., Bilge, A.K., Nişli, K., & Eker Ömeroğlu, R. (2018). Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring. Journal of Child, 18(1), 29-38. https://doi.org/10.5222/j.child.2018.38278

AMA

Dilek F, Dindar A, Bilge A K, Nişli K, Eker Ömeroğlu R. Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring. Journal of Child. 2018;18(1):29-38. https://doi.org/10.5222/j.child.2018.38278

ABNT

Dilek, F.; Dindar, A.; Bilge, A.K.; Nişli, K.; Eker Ömeroğlu, R. Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring. Journal of Child, [Publisher Location], v. 18, n. 1, p. 29-38, 2018.

Chicago: Author-Date Style

Dilek, Fatih, and Aygün Dindar and Ahmet Kaya Bilge and Kemal Nişli and Rukiye Eker Ömeroğlu. 2018. “Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring.” Journal of Child 18, no. 1: 29-38. https://doi.org/10.5222/j.child.2018.38278

Chicago: Humanities Style

Dilek, Fatih, and Aygün Dindar and Ahmet Kaya Bilge and Kemal Nişli and Rukiye Eker Ömeroğlu. “Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring.” Journal of Child 18, no. 1 (May. 2025): 29-38. https://doi.org/10.5222/j.child.2018.38278

Harvard: Australian Style

Dilek, F & Dindar, A & Bilge, AK & Nişli, K & Eker Ömeroğlu, R 2018, 'Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring', Journal of Child, vol. 18, no. 1, pp. 29-38, viewed 3 May. 2025, https://doi.org/10.5222/j.child.2018.38278

Harvard: Author-Date Style

Dilek, F. and Dindar, A. and Bilge, A.K. and Nişli, K. and Eker Ömeroğlu, R. (2018) ‘Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring’, Journal of Child, 18(1), pp. 29-38. https://doi.org/10.5222/j.child.2018.38278 (3 May. 2025).

MLA

Dilek, Fatih, and Aygün Dindar and Ahmet Kaya Bilge and Kemal Nişli and Rukiye Eker Ömeroğlu. “Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring.” Journal of Child, vol. 18, no. 1, 2018, pp. 29-38. [Database Container], https://doi.org/10.5222/j.child.2018.38278

Vancouver

Dilek F, Dindar A, Bilge AK, Nişli K, Eker Ömeroğlu R. Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring. Journal of Child [Internet]. 3 May. 2025 [cited 3 May. 2025];18(1):29-38. Available from: https://doi.org/10.5222/j.child.2018.38278 doi: 10.5222/j.child.2018.38278

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Dilek, Fatih - Dindar, Aygün - Bilge, AhmetKaya - Nişli, Kemal - Eker Ömeroğlu, Rukiye. “Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring”. Journal of Child 18/1 (May. 2025): 29-38. https://doi.org/10.5222/j.child.2018.38278

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Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring

Akut Antrasiklin Kardiyotoksisitesinin Kalp Hızı Değişkenliği Analizi ve 24 Saatlik Holter Monitorizasyonu ile İncelenmesi

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