Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer

Steven E Lipshultz, Stuart R. Lipsitz, Stephen E. Sallan, Valeriano C. Simbre, Seema L. Shaikh, Suzanne M. Mone, Richard D. Gelber, Steven D. Colan

Research output: Contribution to journalArticle

224 Citations (Scopus)

Abstract

Purpose: A common late effect of doxorubicin therapy for childhood cancer is reduced left-ventricular (LV) wall thickness resulting in elevated LV afterload and depressed LV function. Many children are given angiotensin-converting enzyme inhibitors, which have been studied primarily in adults. We document the long-term effects of angiotensin-converting enzyme inhibitors in doxorubicin-treated survivors of childhood cancer. Patients and Methods: In this retrospective study, we reviewed records of 18 children who had regular echocardiographic examinations during enalapril therapy (mean age at cancer diagnosis, 8 years; mean time between completion of doxorubicin therapy and start of enalapril, 7 years; median follow-up since the start of enalapril, 10 years). Results: Over the first 6 years of enalapril therapy, there was progressive improvement toward normal values in LV dimension, afterload, fractional shortening, and mass, but all these parameters deteriorated between 6 and 10 years. LV wall thickness deteriorated throughout the study period, as did LV contractility and systolic blood pressure. Diastolic blood pressure fell slightly. By 6 years on enalapril, all six patients who had had congestive heart failure at the start of enalapril therapy had either died or undergone cardiac transplantation, compared with three of the 12 asymptomatic patients. Conclusion: In doxorubicin-treated long-term survivors of childhood cancer, enalapril-induced improvement in LV structure and function is transient. The primary defect, which is LV wall thinning, continues to deteriorate, and thus the short-term improvement was mostly related to lowered diastolic blood pressure.

Original languageEnglish
Pages (from-to)4517-4522
Number of pages6
JournalJournal of Clinical Oncology
Volume20
Issue number23
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

Fingerprint

Enalapril
Left Ventricular Dysfunction
Doxorubicin
Survivors
Blood Pressure
Neoplasms
Left Ventricular Function
Angiotensin-Converting Enzyme Inhibitors
Therapeutics
Heart Transplantation
Reference Values
Heart Failure
Retrospective Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Lipshultz, S. E., Lipsitz, S. R., Sallan, S. E., Simbre, V. C., Shaikh, S. L., Mone, S. M., ... Colan, S. D. (2002). Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. Journal of Clinical Oncology, 20(23), 4517-4522. https://doi.org/10.1200/JCO.2002.12.102

Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. / Lipshultz, Steven E; Lipsitz, Stuart R.; Sallan, Stephen E.; Simbre, Valeriano C.; Shaikh, Seema L.; Mone, Suzanne M.; Gelber, Richard D.; Colan, Steven D.

In: Journal of Clinical Oncology, Vol. 20, No. 23, 01.12.2002, p. 4517-4522.

Research output: Contribution to journalArticle

Lipshultz, SE, Lipsitz, SR, Sallan, SE, Simbre, VC, Shaikh, SL, Mone, SM, Gelber, RD & Colan, SD 2002, 'Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer', Journal of Clinical Oncology, vol. 20, no. 23, pp. 4517-4522. https://doi.org/10.1200/JCO.2002.12.102
Lipshultz, Steven E ; Lipsitz, Stuart R. ; Sallan, Stephen E. ; Simbre, Valeriano C. ; Shaikh, Seema L. ; Mone, Suzanne M. ; Gelber, Richard D. ; Colan, Steven D. / Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 23. pp. 4517-4522.
@article{faad5c41ffaa490782e82262f843ebe7,
title = "Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer",
abstract = "Purpose: A common late effect of doxorubicin therapy for childhood cancer is reduced left-ventricular (LV) wall thickness resulting in elevated LV afterload and depressed LV function. Many children are given angiotensin-converting enzyme inhibitors, which have been studied primarily in adults. We document the long-term effects of angiotensin-converting enzyme inhibitors in doxorubicin-treated survivors of childhood cancer. Patients and Methods: In this retrospective study, we reviewed records of 18 children who had regular echocardiographic examinations during enalapril therapy (mean age at cancer diagnosis, 8 years; mean time between completion of doxorubicin therapy and start of enalapril, 7 years; median follow-up since the start of enalapril, 10 years). Results: Over the first 6 years of enalapril therapy, there was progressive improvement toward normal values in LV dimension, afterload, fractional shortening, and mass, but all these parameters deteriorated between 6 and 10 years. LV wall thickness deteriorated throughout the study period, as did LV contractility and systolic blood pressure. Diastolic blood pressure fell slightly. By 6 years on enalapril, all six patients who had had congestive heart failure at the start of enalapril therapy had either died or undergone cardiac transplantation, compared with three of the 12 asymptomatic patients. Conclusion: In doxorubicin-treated long-term survivors of childhood cancer, enalapril-induced improvement in LV structure and function is transient. The primary defect, which is LV wall thinning, continues to deteriorate, and thus the short-term improvement was mostly related to lowered diastolic blood pressure.",
author = "Lipshultz, {Steven E} and Lipsitz, {Stuart R.} and Sallan, {Stephen E.} and Simbre, {Valeriano C.} and Shaikh, {Seema L.} and Mone, {Suzanne M.} and Gelber, {Richard D.} and Colan, {Steven D.}",
year = "2002",
month = "12",
day = "1",
doi = "10.1200/JCO.2002.12.102",
language = "English",
volume = "20",
pages = "4517--4522",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "23",

}

TY - JOUR

T1 - Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer

AU - Lipshultz, Steven E

AU - Lipsitz, Stuart R.

AU - Sallan, Stephen E.

AU - Simbre, Valeriano C.

AU - Shaikh, Seema L.

AU - Mone, Suzanne M.

AU - Gelber, Richard D.

AU - Colan, Steven D.

PY - 2002/12/1

Y1 - 2002/12/1

N2 - Purpose: A common late effect of doxorubicin therapy for childhood cancer is reduced left-ventricular (LV) wall thickness resulting in elevated LV afterload and depressed LV function. Many children are given angiotensin-converting enzyme inhibitors, which have been studied primarily in adults. We document the long-term effects of angiotensin-converting enzyme inhibitors in doxorubicin-treated survivors of childhood cancer. Patients and Methods: In this retrospective study, we reviewed records of 18 children who had regular echocardiographic examinations during enalapril therapy (mean age at cancer diagnosis, 8 years; mean time between completion of doxorubicin therapy and start of enalapril, 7 years; median follow-up since the start of enalapril, 10 years). Results: Over the first 6 years of enalapril therapy, there was progressive improvement toward normal values in LV dimension, afterload, fractional shortening, and mass, but all these parameters deteriorated between 6 and 10 years. LV wall thickness deteriorated throughout the study period, as did LV contractility and systolic blood pressure. Diastolic blood pressure fell slightly. By 6 years on enalapril, all six patients who had had congestive heart failure at the start of enalapril therapy had either died or undergone cardiac transplantation, compared with three of the 12 asymptomatic patients. Conclusion: In doxorubicin-treated long-term survivors of childhood cancer, enalapril-induced improvement in LV structure and function is transient. The primary defect, which is LV wall thinning, continues to deteriorate, and thus the short-term improvement was mostly related to lowered diastolic blood pressure.

AB - Purpose: A common late effect of doxorubicin therapy for childhood cancer is reduced left-ventricular (LV) wall thickness resulting in elevated LV afterload and depressed LV function. Many children are given angiotensin-converting enzyme inhibitors, which have been studied primarily in adults. We document the long-term effects of angiotensin-converting enzyme inhibitors in doxorubicin-treated survivors of childhood cancer. Patients and Methods: In this retrospective study, we reviewed records of 18 children who had regular echocardiographic examinations during enalapril therapy (mean age at cancer diagnosis, 8 years; mean time between completion of doxorubicin therapy and start of enalapril, 7 years; median follow-up since the start of enalapril, 10 years). Results: Over the first 6 years of enalapril therapy, there was progressive improvement toward normal values in LV dimension, afterload, fractional shortening, and mass, but all these parameters deteriorated between 6 and 10 years. LV wall thickness deteriorated throughout the study period, as did LV contractility and systolic blood pressure. Diastolic blood pressure fell slightly. By 6 years on enalapril, all six patients who had had congestive heart failure at the start of enalapril therapy had either died or undergone cardiac transplantation, compared with three of the 12 asymptomatic patients. Conclusion: In doxorubicin-treated long-term survivors of childhood cancer, enalapril-induced improvement in LV structure and function is transient. The primary defect, which is LV wall thinning, continues to deteriorate, and thus the short-term improvement was mostly related to lowered diastolic blood pressure.

UR - http://www.scopus.com/inward/record.url?scp=0036895164&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036895164&partnerID=8YFLogxK

U2 - 10.1200/JCO.2002.12.102

DO - 10.1200/JCO.2002.12.102

M3 - Article

VL - 20

SP - 4517

EP - 4522

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 23

ER -