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1 13E066ﾑ80803 ﾇｦｦﾐﾒﾇ 096ﾑ8 6ﾑ8ｦﾇ M0003 閨ｧｹｸｦｸｦ0 apple00apple0206 6ｧ9080ｸ7 (026ｦ0apple080ｸ7-ｦﾌ) 0ｷ30ｹ0 006ｧ fi ｹ apple 閨0ｹｧｹ0 ﾞ. ｦｧ9 090ｹ01, ｦﾌ. ｦｸ7036ｧ9 080ｸ71, apple 09000ｷ303096ｧ9080ｸ71, ﾞ. 縺 fiapple080ｸ703080ｹ01, 09. ﾒｦ0ｨB090ｹ02, 02. ﾞｸ7-0906apple000308apple086ｦ003080ｸ71 1 ｦﾌｧ8 ﾒｧ8 ﾞ.09.05, ｧ908 ﾞ016ﾑ809 ﾞ, ｧﾑｧﾒｧ80ｹ0 ｦﾌｧ9 0ｹ0 ( ﾒｧ80ｹｧ9 0ｹ0) ﾞ.09.05, ｧ908 ﾞ016ﾑ809 ﾞ, ｧ90209 Tragiannidis A, Tsotoulidou V, Papageorgiou Th, Giannopoulos A, Karamouzis M, Athanasiadou-Piperopoulou F. Evaluation of brain natriuretic peptide (type-b) as predictor of cardiotoxicity in children with haematological malignancies. 1 2 nd Pediatric Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki 2 Clinical Biochemistry Lab, AHEPA University Hospital, Aristotle University of Thessaloniki. Paediatr N Gr 2009, 21: ｧﾇｧ apple000ｸ apple030ｷ fi03030ｷ307 apple080ｸ7 apple ｸｸ702036ｧ907000ｹ apple ｧｧｧｷ30402fi fi ｧ9ｨB apple03fi apple ｷ fi ｷｾ40208applefi0ｹｹ0 apple030808apple ｧ80ｹ閨02090ｹ0 00 0ｹ0 6ｧｧｸ7 026ｦ0apple080ｸ7 ｦﾌ 6ｧｦｸｦ0 apple00apple0206 6ｧ9080ｸ7 (Btype or brain natriuretic peptide; BNP) 0ｷ30ｹ0 apple ｸ7 006ｧ fi ｹｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ apple 閨0ｹｧｹ fi 02090ｹ閨02090ｹ0 00 0ｹ0 apple0802 閨 apple (00 閨ｧ9 7 ﾀ4.21 閨0209) 閨0ｹｧｹ0. ﾌｧ90ｹｧｷ30409 (t=0) ｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ0 (t=1). 縺ｧ8 閨ｧ8 020ｷ閨070ｷ307 (086ｦ00308, ｧ9 ), 02080ｸ7 0ｸ7apple ｧｸｧｹ0, 02090ｹｧ80ｹ0 fi04090ｹｸ (mg/m 2 ) ｹ閨ｸ7 BNP ｸ70ｹ0 apple fi ｸ70ｹ0 0403fi07080ｸ70ｹ0. 6ﾑ8apple06apple , ｧｹ閨02090ｹ0 閨ｧｹ0 040ｸｧ80ｹｸ703096ｧ9 0ｹｹｧ80ｹｧ9 0ｹ閨ｸｹｹ0 (ejection fraction; EF) ｸｹｸｹ0 (shortening fraction; FS) ｸ7apple ｹｸ70ｹ0 0403fi07080ｸ70ｹｧﾞapple 閨 : ﾞapplefi ｸ7apple ｧｧｧｷ apple apple ｧｧ8 EF Abstract. The use of intensive effective antineoplastic chemotherapy that includes anthracyclines in children with malignancies is known to be related to early and late cardiovascular abnormalities. Aim of our prospective study was to evaluate BNP values as an early index of cardiotoxicity after completion of intensive chemotherapy in children with hematological malignancies. Twenty children (mean age 7 ﾀ4.21 years) with hematological malignancies were included. Patients were evaluated at diagnosis (t=0) and after completion of intensive chemotherapy (t=1). For each patient demographic data (sex, age), underlying disease, cumulative anthracyclines dose (mg/m 2 ) and measurement of BNP were registered. Moreover, for each patient we evaluated systolic function of left ventricle with measurement of ejection fraction (EF) and shortening fraction (FS) by echocardiography in times 0 and 1 respectively. Results: Pathological values for EF (<64%) and FS (<29%) were found in 4 (20%) and 1 (5%) patient in t=1, while respective values were normal at diagnosis (t=0). Mean BNP values at t=0 were ﾀ19.95 pg/ml and differ significantly from values at t=1 ( ﾀ29.14 pg/ ml) (p=0.04). Mean value of EF also differs significantly (75.42 ﾀ4.11% vs ﾀ10.51%, p=0.04). No statistic difference was found regarding FS

2 ｧ8 B ﾌ066ﾑ8I ﾌ08 6ﾑ8 ﾞ04 ﾌ6ｾ4, 21, (<64%) FS (<29%) (20%) (5%) ｧｧ fi0708 1, ｧｹ閨0ｹ0 6ｧｸ閨0ｹｷﾇ 00 閨ｧｸ7 BNP ｷ30409 (t=0) 6ｧﾀ pg/ml 閨 applefi ｧ fi0708 t=1 ( ﾀ29.14 pg/ml) (p=0.04). ﾇ 00 閨ｧｸ7 EF 06 閨ｸ70ｹ0 0403fi07080ｸ70ｹ0 00 閨ｹ0 (75.42 ﾀ4.11% 閨ﾀ 10.51%, p=0.04). ｦ閨03080ｹ0, ｧ fi ｹ閨0ｹｸ7 FS ｸ70ｹｧ90ｹｹ閨02090ｹ0 (p=0.102). 6ｾ40ｸ700apple , apple ｦ0apple fi ｧｷｸ fi fi apple 閨0ｹｧｹ0. ｦ 08 BNP apple ｧｧｧｸｧ80ｹｹ apple ｧ apple ｧ apple ｧｸ閨ｧｸ7apple ｹ0 020ｷ307 apple ｸｦｦ007080ｸ7. 閨ｹ : ｸ702036ｧ907000ｹ0, fi020902, fi ｸ fi apple00apple026ｧ9 0608, 閨0ｹｧｹ0. values at times 0 and 1 (p=0.102). In conclusion, our data indicate that anthracyclines related cardiotoxicity may be detected both clinically and laboratory in children with hematological malignancies. BNP represents a useful marker of myocardial dysfunction and therefore, can be used for the early detection and evaluation with echocardiography of high risk children for anthracyclines related cardiotoxicity Key words: anthracyclines, cardiotoxicity, brain natriuretic peptide, hematological malignancies. E ｷ3096ｧ8 ﾇ 0707apple020ｸｧ8 apple ｧ80ｹ apple ｧ80ｹ apple006ｧ9 0ｹ apple fi ｧ90708 apple ｧ fi 00apple6ｧ902000ｸｹ0 046ｦｹｧ80ｹ0. ﾇｧ80ｹｦ fi04080ｸ7 00apple066 56ｧ90ｷ30409 apple ｧｧｧ9ｨB % ｹ0 ﾇ09 ﾞｸｧ8 6ﾑ80ｸ70306apple ｷ30ｹ0 apple ｧ9 apple03fi ｹ0 046ｦｹｧ80ｹ0 ﾞｧ9 0ｹ0- ﾌｧ9 0ｹ apple ｷｸ apple ｷ fi ｷ307 00apple06apple applefi apple006ｧ9 1,2. 6ｾ46ｦ000080ｷ apple03fi ｸ700 閨07 apple 閨 apple080ｸｦ007 00apple06- ｨB ｹ0 applefi apple fi ｧ90708 (Childhood Cancer Survivor Study; CCSS) apple ｦ0apple fi apple6ｧ9apple020ｷ fi07060ｷ307 apple ｷ307 0ｸ709006ｧ9 0ｹ0 applefi ｷｹ apple006ｧ9 0ｹ0 07 閨 %, ｷ307 08apple086ｧ90ｷ % 閨0ｹ apple 閨0ｹｨB0ｷ36ｧ8 00apple06apple 閨0ｹ03. ﾒ0ｸ7036ｧ閨ｦ0 020ｷ307 apple ｷ307 00apple06apple 閨 fi applefi 02060ｹｸ702036ｧｹﾇ 04036ｧｸ70ｹ0 006ｧｸ703006ｧ9 02fi 閨0ｹｧｹ0 fi ｸ700apple 09006ｧ90ｹ0 fi ｸ70ｹｹ0 apple ｧ80ｹｧ9 0ｹ0. 08apple ｧ9ｨB fi0206 apple00036ｧ9apple080ｸ % 020ｷ307 apple ｧｸ702036ｧ907000ｹｹ apple006ｧ9 0ｹｸ70407fi apple ｦｹ0 006ｧｸｧ90709 (doxorubicin; DOXO), ｸｸｧ90709 (daunorubicin; DNR), 09 00apple ｸｧ90709 (epirubicin; EPI) ｸｧ90709 (idarubicin; IDA). ﾌ06 apple ｹ閨02000ｹｧｹｹｧ80ｹｹ0 020ｷｸｧｹ0 閨ｷ30ｹ閨0ｹ0 fi ｸｧ80ｹｧ80ｹ0 fi04090ｹｧ8 <550 mg/m ｷ30ｹ0, 0700fi ｹ閨02000ｹ apple ｦ00ｹｧ90ｹ0 apple 陦 fi ｸｧｧ8 fi ｸﾝ300 mg/m ｧ9- ｨB ｧ8030ｷｸ7apple ｧ80ｹｧ80ｹ0 0ｸｸ703096ｧ9 0ｹｧ80ｹ fi07 0ｹ0 000ｸ apple ｹ01,3. ｦ閨03080ｹ0, 0700fi 閨07 0ｸ7apple ｧ9ｨB080ｸ707 fi apple000ｸ fi apple0802 閨 applefi ｧｧｸ70ｹｧ90ｹ閨0ｹ0 fi ｹ0 apple080ｸ7 020ｸ700 6ｧ applefi mg/m 2 0ｸ7apple0003 閨ｹｸｧ80ｹｸ70ｹｹ apple 閨 fi020902, 09 0ｸｧｦ fi ｸ7 00apple066 56ｧ90ｷ30409 applefi ｧ8 apple030ｷ fi03030ｷ307 apple080ｸ7 apple ｸｸ702036ｧ907000ｹ0 apple ｧ9ｨb ｧ apple000ｸｷｦｸ apple00apple026ｧ9 06 apple ｦ fi07000ｹｧ80ｹｧ80ｹ0 apple0308 閨03000ｸ704090ｹ閨ｧｸ70ｹｷ303006ｧ fi ｸ703006ｧ9ｨB applefi ｸｹｹｧ80ｹｧ9 0ｹ0. 6ﾑ8apple0800 閨070ｷ30ｹ0, ｦｸｸ apple00apple0206 6ｧ90ｷ apple02036ｧ9ｨB ｦｹｧ80ｹ0 0ｸｸ703096ｧ9 0ｹ0. 6ｾ40ｸ閨07, applefi 000ｸ7036ｧｧｹ0, 02 00apple6ｧ9apple ｸ70ｹ0 閨04080ｸｸｧｧｸ703096ｧｸｧｧ8 0700apple /6ｧ8 閨ｸ7 000ｸｧ9080ｸ閨ｧ閨04080ｸｧｸ apple00apple026ｧ9 06 : apple0602fi (atrial natriuretic peptid; ANP), fi (ｦﾌ-type or brain natriuretic peptide; BNP) ｦ0apple080ｸ7 C (C-natriuretic peptide; CNP). ｦ ANP BNP 02fi 閨040ｷ3 020ｷｸ

3 ｧ8 B ﾌ066ﾑ8I ﾌ08 6ﾑ8 ﾞ04 ﾌ6ｾ4, 21, 2 080ｸｧ8020ｷｸ70ｹ0 fi 閨040ｷｸｷｦｸ70ｹｦｧ907090ｹｧ907090ｹ fi07090ｹ0 00apple ｨB080ｸ apple6ｧｸｸ fi. ｦ 08 pro-bnp apple 閨陦, ｧｸ7036ｧ90ｷ30ｹ0 applefi ｧｧｸ707 閨 apple ｸ fi fi BNP fi 02006ｧ800 NT-proBNP 15,16. ｦ 08 BNP 閨 apple 閨ｧ閨ｹｸ703096ｧ9 0ｹｸｦ0 040ｸ704026ｧｹｸ70ｹｧｹ014. 6ｾ40208applefi0ｹｹ0 apple 03086ｦ004 0ｹ閨02090ｹ0 6ｧｧｸ7 BNP 0ｷ30ｹ0 apple ｸ7 006ｧ fi ｹｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ apple 閨0ｹｧｹ fi 閨ｹ0 ﾞｧ90ｹ fi 02090ｹ閨02090ｹ0 00 0ｹ0 apple0802 閨 apple 閨0ｹｧｹ0 ( ｧｧｸｧ9 ; ﾌ, ｧ9 000ｸｧｸｧ9 ; ﾌ09, 0009 Hodgkin 03 閨00080ｷ300 ; NHL, 07fi04080ｹ0 Hodgkin; HD) apple080ｸｦｦﾌｯｧ8 ﾒｧｸ7 ﾞﾒ 07006ｧ90ｹ0 applefi 02080ｸ70ｹｧ90ｹ鐶pple applefi 0ｸ7apple ｧｸｧ8 6ｧ8 00apple6ｧｧ8 07fi ｷﾇ 040ｸｧｧ8 fi ｷｸｸ7apple ｧｷ30ｹｦ fi ｸｸｧ907090ｹ0 6ｧｸｧ907090ｹ0 046ｦ000080ｷ閨0409 1: ｦｸｸｧ907090ｹ0 6ｧｸｧ907090ｹ0 apple03080ｹｸｧﾌｧ90ｹﾌ, NHL HD 閨ｸｧｧ8 fi ｸ <300 mg/m 2, ｧ fi ｸ70ｹｧ90ｹﾌ09 6ｧ >300 mg/m 閨ｹ0 縺ｧ8 閨ｧ8 020ｷ ( ｧ9, 086ｦ00308) (0ｸ7apple ｧ fi040900, ｧｧｧ ) / apple ｸｷ307 (BNP, 0ｸ7apple ｹ0, ) ｷ30409 (0403fi07080ｹ0 t=0) ｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ0 apple080ｸ7 apple ｸ702036ｧ907000ｹ0 (0403fi07080ｹ0 t=1). 6ｾ40ｸ閨07, fi ｸ7apple ｸ7036ｧｷ閨ｧｹ0 apple 03080ｸ7046ｧ9 0ｹｧ80ｹ0 040ｸｧ80ｹ0 ( 閨0ｹ0 070ｷｧ9000ｹ0, 03030ｸ703006ｧ9000ｹ0, 000ｸｧ90206, apple ｧ90206, ｧ9 07 閨02030ｷｸ7 000ｸｧ9080ｸ7, ｧ8 0700apple ｸ apple ) ｸ70ｹ0 apple fi ｸ70ｹ0 0403fi07080ｸ70ｹ0. 縺ｧ8 閨ｧｹ0 040ｸｧ80ｹｸ703096ｧ9 0ｹｹｧ80ｹｧ9 0ｹ閨ｸｹｹ0 (ejection fraction; EF) ｸｹｸｹ0 (shortening fraction; FS) ｸ7apple ｹｸ70ｹ0 0403fi07080ｸ70ｹｧｹ0 apple 閨0ｹｧ閨0ｹ0 <29% <64% FS EF 07026ｧｹ0 08apple086ｧ9000ｹ閨ｸ7apple fi0ｹｧｦ0-0308, 08086ｦ apple ｨB ｦ000080ｷ閨07 applefi 02060ｹ0 apple 閨ｸ70ｹ0 0ｸ702 閨0ｹ018. 6ﾑ8apple06apple , applefi 02 0ｸ7apple ｸ7036ｧ閨ｸ7apple fi0ｹｹ0 0007ｨB 0ｹｹｧ80ｹｧ9 0ｹｸｧ8 (left ventricular systolic mass; LVs mass) ｧ8 (left ventricular diastolic mass; LVd mass) ｸ70ｹ0 0403fi07080ｸ70ｹｧｦ閨03080ｹ0, ｧ8 閨 apple fi0ｹｸ7 BNP (pg/ml) ﾑｧﾒｧ80ｹ0 ｦﾌｧ9 0ｹ0 ( ﾒｧ80ｹｧ9 0ｹ0) 02080ｸ7 ﾞｧ8 00 閨ｷ302 6ｦｹ0 ( ｰECLIA ｱ) ｷｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ0. ﾌ閨0ｹｸ7 BNP ｷ307 0ｸ7apple ｸｷｷ fi ｸｧｹｧｹｷｹｧ80ｹｧｹ0 (t=0). 6ｾｧｸ70409 ﾇｧｸｷ307 apple ｷ307 閨 fi apple03fi SPSS (version 13.0). ﾇ 00 閨ｹｹｧ80ｹｸ704090ｹ0 apple ｸ7apple fi ｧｹ0 00 閨04090ｹｧ80ｹ0 (mean), 02090ｹ閨04080ｸｧ80ｹ0 (median), 02090ｹｧ80ｹ0 applefi ｹ0 (standard deviation, SD) ｸｦｹｸ7 00 閨04080ｸ7 fi03080ｸ7 (standard error of the mean, SEM). 縺閨 fi ｹ fi ｧ9 t-test 0906 apple ｧｹｨB006ｦ00909 (t-test for paired observations) ｦ0 020ｷｷｸ70ｹ0 0403fi07080ｸ70ｹｧｹ0 fi ｧ80ｹ fi ｹｧｧ8 p<0.05. ﾞapple 閨ﾇ apple 03086ｦ閨ｧ applefi ｦﾐ 07080ｸｸ閨0ｷ30ｹｾ400apple02 閨ｸﾞapplefi 02080ｸ70ｹｧ90ｹ0 apple080ｸ閨 (60%) 6ｧ fi (40%) ｧ , 閨ｧｷｧﾀ4.21 閨0209. ﾇ 0ｸ7apple ｧｧｧｧﾌｧ90ｹ0, ﾌ , NHL HD ｧ8. ﾞapplefi ｸ7apple ｧｧｧｷｹ閨02090ｹ0 00 0ｹ0 06 apple apple ｧｧ8 EF (<64%) FS (<29%) (20%) (5%) ｧｧ fi0708 1, ｧｹ閨0ｹ0 fi030ｷｷｧｸ閨0ｹｷ30409 (t=0). 6ｾ400 閨ｧ8 06 apple ｧ8 apple ｧ8 040ｸｧ fi ｦ 0ｸ7apple00-

4 ｧ8 B ﾌ066ﾑ8I ﾌ08 6ﾑ8 ﾞ04 ﾌ6ｾ4, 21, Ejection fraction; EF (%) Shortening fraction; FS (%) Time 6ｾｦｷｸｹｹ0 (ejection fraction; EF) 020ｷ apple000602fi ｹ0 00 閨04090ｹｧ80ｹｸ7 (mean) (080306ｨBfi ｧ fi0ｹ0 020ｷ307 apple ｷ307) ｸ70ｹ0 0403fi07080ｸ70ｹ0 00 閨ｹｧｦ fi (25% 020ｷ307 apple ｧ804000ｷ307) fi (75% 020ｷ307 apple ｧ804000ｷ307) apple 03080ｸｨB ｷｷｸ7 apple ｸ7. ｦ閨03080ｹ0, ｨBfi ｹ閨0ｹ0 apple080ｸ7 apple ｸ fi0ｹｸ7 apple ｸ apple ｷ3apple006ｦ0080ｸｧ % apple ｦ007090ｹｹ0 00 閨04090ｹｧ80ｹｸ7 EF ｸ7036ｧｷｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ0 (t=1) 6ｧｧ80ｹ0 000ｸ apple ｹ閨ｧｸｦ0 0700apple ｹｦ00ｹｧ9 0ｹ0 (MVR) fi0009 閨ﾌｧｹ閨0ｹｸ7 EF ｸ7 FS 6ｧ apple 閨0ｹ0 (<64% <29% 07026ｧ ) ｸ70ｹ0 2 0ｸ702086ｦ00ｹｧ90ｹｸ7-036ｧｸｦ閨ｸ7 020ｷｷｧ9000ｹ0 02fi ｷ30409 fi apple 07 閨ｧ8-030ｷｹｧ80ｹ apple006ｧ9 0ｹ0 (t=1). ﾇ 00 閨ｧｸ7 EF 06 閨ｸ70ｹ0 0403fi ｸ70ｹ0 00 閨ｹ0 (75.42 ﾀ4.11% fi 閨ﾀ10.51% fi0708 1) (p=0.04) (6ｾ404. 1) 閨ｧｸ7 FS ｧｸ70ｹｧ90ｹｹ閨02090ｹ0 (43.61 ﾀ3.74% 閨ﾀ6.93% ｸ70ｹ0 0403fi07080ｸ70ｹｧ ) (p=0.102) (6ｾ404. 2). ﾞapplefi ｸ70404 閨 Time 6ｾｦｷｸｹｸｹ0 (shortening fraction; FS) 020ｷ apple000602fi ｹｹｧ80ｹｸ7 (mean) (080306ｨBfi ｧ fi0ｹ0 020ｷ307 apple ｷ307) ｸ70ｹ0 0403fi07080ｸ70ｹ0 00 閨ｹｧｦ fi (25% 020ｷ307 apple ｧ804000ｷ307) fi (75% 020ｷ307 apple ｧ804000ｷ307) apple 03080ｸｨB ｷｷｸ7 apple ｸ7. ｦ閨03080ｹ0, ｨBfi ｹ閨0ｹ0 apple080ｸ7 apple ｸ fi0ｹｸ7 apple ｸ apple ｷ3apple006ｦ0080ｸｧ % apple ｦ007090ｹｹｹｧ80ｹｸ7 FS ｷ閨040ｷｹ0 0007ｨB 0ｹｹｧ80ｹｧ9 0ｹｸｧ8 (LVs mass) ｧ8 (LVd mass) 0007 apple0308 閨020ｸ閨0ｹ閨0ｹｸ70ｹ0 0403fi07080ｸ70ｹｧﾑ8apple06apple03 閨0807, 閨ｧｸ7 BNP ｷ30409 (t=0) 6ｧﾀ19.95 pg/ml 閨 applefi ｧ fi0708 t=1 ( ﾀ29.14 pg/ml) (p=0.04) (6ｾ404. 3). ｦ apple 閨 fi030ｷｷ307 apple 閨02030ｷｹ閨02090ｹ0 08 6ｧ apple6ｧﾞapplefi ｸ70404 閨ｦ0 020ｷｸ7 EF, 02080ｸ7 FS ｸ7 BNP ｦ00308, ｸ7apple ｧ fi040900, ｧ9 (<5, > ) ｸｧｧ8 fi ｷｸ (<300 mg/m 2, >300 mg/ m 2 ) 0007 apple0308 閨020ｸ閨0ｹ閨0ｹｧ8030ｷｹ apple006ｧ9 0ｹ0. ｦ閨03080ｹ0, 閨0ｹｸ7 BNP fi 006ｧｧｧ8 040ｸ70404 閨ｹｧｹｸ7 EF fi (r=-0.535, p<0.05). 096ｧｹ0 1. ﾞapple 閨ｷ307 apple 閨02030ｷ307 apple080ｸｧｸ70ｹ0 0403fi07080ｸ70ｹｧ t=0 t=1 p EF (ejection fraction;%) ﾀﾀ FS (shortening fraction; %) ﾀﾀ LVs mass (left ventricular systolic mass; g) ﾀﾀ LVd mass (left ventricular diastolic mass; g) ﾀﾀ BNP (Brain Natriuretic Peptide; pg/ml) ﾀﾀ

5 ｧ8 B ﾌ066ﾑ8I ﾌ08 6ﾑ8 ﾞ04 ﾌ6ｾ4, 21, 2 Brain Natriuretic Peptide; BNP (pg/ml) ｾ40ｸ7ｨB6ｧ Time 6ｾｦｷｸｦｸｦ0 apple00apple0206 6ｧ9080ｸ7 (brain natriuretic peptide; BNP) 020ｷ apple000602fi ｹ0 00 閨04090ｹｧ80ｹｸ7 (mean) (080306ｨBfi ｧ fi0ｹ0 020ｷ307 apple ｷ307) ｸ70ｹ0 0403fi07080ｸ70ｹ0 00 閨ｹｧｦ fi (25% 020ｷ307 apple ｧ804000ｷ307) fi (75% 020ｷ307 apple ｧ804000ｷ307) apple 03080ｸｨB ｷｷｸ7 apple ｸ7. ｦ閨03080ｹ0, ｨBfi ｹ閨0ｹ0 apple080ｸ7 apple ｸ fi0ｹｸ7 apple ｸ apple ｷ3apple006ｦ0080ｸｧ % apple ｦ007090ｹｹ0 00 閨04090ｹｧ80ｹ0 BNP. ﾇ 00apple6ｧ applefi ｧｸｧｸ703096ｧ9 apple ｧ apple ｸ7-036ｧ90ｷ30ｹ0 040ｸ700apple020ｷ閨0ｹ閨0ｹ0 070ｷｧ9000ｹ0, 6ｧ8apple06080ｸｦ0 0ｸ7applefi , 03030ｸ703006ｧ9000ｹ0, 000ｸｧ90206, apple ｧ90206, ｧ9 07 閨02030ｷｸ7 000ｸｧ9-080ｸ7, ｧ8 0700apple ｸ apple ﾇ fi applefi ｸ702036ｧ907000ｹ fi ｧ8030ｷ3046ｧ80ｹｹｧ9000ｹ09-12 : 1. ﾌ01006ｧ9, 09 08apple086ｧ9 apple ｸｧｧ8apple06 0ｹｦｹｧ8 0700apple apple080ｸ7 0ｸ7apple08-040ｷ303006ｧ9 040ｸ7076ｧ8030ｷ30ｹ fi0ｹ0 006ｧ9 0ｹｹ0 applefi ｧ8030ｷｹｧｹ0. ﾇ 00apple6ｧ9apple020ｷ3046ｧｹ0 046ｦ000080ｷ閨07 006ｧｧ閨 apple fi <1% 10, fi0706 apple ｸｧ8 000ｸ apple , apple080ｸ fi0ｹ0 0007fi0ｹ0 閨02080ｸ70ｹ0 applefi ｧ8030ｷｹ apple006ｧ9-0ｹｸ702036ｧ907000ｹｧ9ｨB applefi 閨0ｹ0 070ｷｧ9000ｹ0, 0ｸｸ703096ｧｹｧ80ｹｧ9 0ｹ apple 0706fi applefi 閨0ｹｹｧ80ｹ0 0700apple ｹ09-12, 閨03080ｹ0, fi0706 apple ｸｧ8 000ｸ apple apple080ｸ閨07 閨02080ｹｧ8030ｷｹ apple006ｧ9 0ｹｸ702036ｧ907000ｹｧ9ｨB apple ｧ9070ｷｹｸ703096ｧ9 0ｹｸｦ0 000ｸ7fi0ｹ0 03fi090ｷｧ80ｹ apple ｹ0 000ｸ708020ｸｷ307. 6ﾑ8apple6ｧ904090ｹ0, 閨04080ｸ707 apple ｧ9 apple000306apple ｹ apple080ｸｧ9- ｨB080ｸ鐶pple020ｸｸｹｹｧ80ｹｧ9 0ｹｸ70708 fi ,19. ﾌ fi0ｹ apple ｧｹ fi ｹ0 applefi ｸ702036ｧ907000ｹ閨ｦ0 020ｷｸ7apple ｹ0 fi fi ｧ8 apple fi apple 03080ｸ7046ｧ apple08apple08066ｧｷ307 6ｧ apple 03 09fi07020ｷｦ007080ｸ7 040ｸｸｧ8030ｷ3046ｧｹ0. 6ｾ46ｦ000080ｷ閨 apple08apple08066ｧ apple ｹｦ007080ｸ7 006ｧｧｧ9, ｧ8030ｸ7 086ｦｧ8 apple ,5. ｦ 0308apple08apple08066ｧ apple ｹｦ007080ｸｧ8030ｷ fi ｹ0 applefi ｸ702036ｧ907000ｹ0 006ｧｸｧｧｸ70ｹ0 fi0409, fi07080ｹｧｹ0, ｸｧ8 fi apple006ｧ9 0ｹ閨03080ｹｸｧｷ307 0ｸ apple000ｸ apple 03 09fi07020ｷ307 3,5. ｦｸ apple00apple026ｧ9 06 apple ｦｸ7 6ｧｸ70ｹ0 006ｧｹｧ80ｹ0 0ｸｸ703096ｧ9 0ｹｧｹｧ90ｹ0. ｦ 08 ANP ｧｸ7036ｧ90ｷ30ｹ0 applefi ｸ708026ｦｷ307 02fi03apple0ｷ BNP applefi ｧｷ applefi apple6ｧｷ307 apple080ｸ7 apple ｦ007 stress ｸ fi0308 apple080ｸｦｸ apple00apple026ｧ9 06 0ｸｸｧｹｧ8 0700apple , 0208 BNP apple ｧ9 apple fi ｸ7-6ｧｧｦ ANP apple ｸｸ703096ｧ9 0ｹｹｧ80ｹｧ9 0ｹ0 046ｦ000080ｷ apple03fi ｸ7036ｧ ,22. 6ｾ400 apple ｦ00ｹｧ90ｹ0 09 6ｦｸ7 BNP 閨ｸｧｸ7apple ｸ7036ｧｧ80ｹ0 0ｸｸ703096ｧ9 0ｹｦｷｸ7 閨04080ｸｧ apple ｧ8 0700apple ｧ apple080ｸ7 00apple ｨB080ｸｧｸ703096ｧ9, fiapple0ｷ30ｹ fi04080ｹ0 Kawasaki 23,24. ﾞapplefi ｸ7036ｧｹ閨02090ｹ0 00 0ｹｷｹ0 00 閨04090ｹｧ80ｹｸ7 EF FS ｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ apple 閨0ｹｧｹｦｹｧｹ閨0ｹｷｹ0 07fi04080ｸ7. ｦ 0ｸ7apple apple 閨ｹ閨02090ｹ0 00 0ｹ0 006ｧ apple036ｧｧｧｷｦ000080ｷｸ7036ｧｷ307 08apple086ｧ90ｷｷｷｸ7 EF ｸ7 FS ｸ707 0ｸ7 0400fi ｸ70708 fi ｧ8 040ｸ700apple020ｷｧ閨07080ｸ70ｹｧ90ｹ閨閨07 0ｸ7apple ｸｧ8 00 閨ｹｸ7 BNP 0400 apple ｦ00ｹｧ90ｹｧ90708 apple080ｸ7 閨ｸ702036ｧ907000ｹ0. 6ｾ46ｦ000080ｷｸ7036ｧ閨02090ｹ0 020ｷ307 Hayakawa ｸ apple ｸｸ703096ｧｹ0

6 ｧ8 B ﾌ066ﾑ8I ﾌ08 6ﾑ8 ﾞ04 ﾌ6ｾ4, 21, ｧ80ｹｧ9 0ｹ /34 (23.5%) apple 閨0ｹｧｹ0 閨07 006ｧｧ8030ｷｹ apple006ｧ9 0ｹｸ702036ｧ907000ｹ0, 閨0ｹｸ7 BNP 020ｷ閨 fi0408 applefi 02060ｹｧｹｹ閨ｸ7 (0ｸｧ90ｹｸ703000ｹ0) fi ｸｧｧｸ703096ｧｾ400 apple03fi 閨ｷ307 Ekstein ｸ apple apple ｧｸ閨0ｹ閨0ｹ0 BNP ｧｧ9 0ｹ0 fi ｹｸｧ907090ｹ0 apple080ｸ7 06 閨 applefi 02060ｹｧｹｷｾ46ｦ000080ｷ fi 閨07 apple ｦ0apple fi0206 0ｸ閨0ｹ閨0ｹ0 BNP ｧｹｧ80ｹｸ703096ｧ9 0ｹ0, fiapple0ｷ30ｹ0 0ｸ7026ｧｷｷ307 EF FS, 06 apple apple ﾌ, ﾌ Hodgkin 03 閨00080ｷ300 02fi ｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ0 fi 閨02000ｹ0 00apple06ｨB ｷ307 applefi apple fi ｧｦ閨03080ｹ0, 046ｦ000080ｷ apple03fi ｧ閨 apple ﾌｹｹ0 BFM 000ｸ apple % 0ｸ , fi0ｹ0 apple080ｸｦ fi0ｹ fi ｹ0 apple ｹｹ0 020ｷ307 apple ｸｦｦ007080ｸ閨03080ｸ apple ｦｹ0 020ｷ307 00apple06- ｨB ｷ fi fi ｷ30ｹ fi0706 applefi ｧ8030ｷｹ apple006ｧ9 0ｹ07. ﾞapplefi ｧｸｷ307 apple ｷｹ0 06 apple ｸ70404 閨ｦ0 020ｷｸ7 BNP ｸ7 EF fi0708 1, fi0ｹ0 apple080ｸｦｸ7applefi fi BNP apple ｧ fi0ｹ0 006ｧｧ80ｹ0 0ｸｸ703096ｧ9 0ｹ閨03080ｸ閨ｧｸ apple apple080ｸｸｸ702036ｧ907000ｹ0 00apple ｧｸ apple ｷｹ0 000ｸｧ80ｹｹｧ9040ｷ30ｹｹ閨ｧ80ｹｹ030,31. ﾌ 00fi07080ｹ0 apple fi0ｹｹ閨02090ｹ0 00 0ｹ0 006ｧ fi0ｹ fi0ｹｾｹｦｹ fi0ｹｹ0 00apple6ｧ904090ｹ apple 閨ｹ閨02090ｹ apple06ｨB ｹ0 applefi apple fi ｧ fi ｧ8030ｷｹ apple006ｧ9 0ｹｸ702036ｧ907000ｹ apple 閨020300apple ｷ3-096ｧ閨ｷ307 apple ｷｸｧ904000ｷ307. 6ｾ40ｸ700apple , applefi 閨ｹ0 apple ｦ0apple fi ｸ702036ｧ907000ｹｦｧ apple086ｧ fi fi ｷｷｸ7 EF ｸ7 FS ｧ8030ｷｹｧ80ｹ apple006ｧ9 0ｹ0 apple 閨0ｹｧｹ0. 6ﾑ8apple06apple03 閨0807, 046ｦ000080ｷ apple 閨ｹ0 06 apple fi 閨0ｹｸ7 BNP 0ｸｸ apple006ｧｸ702036ｧ907000ｹ apple0800 閨070ｷ30ｹ0, apple ｦｧｧ閨ｸｦｦ007080ｸｸ apple applefi ｧｸｦﾌｧ9 1. Alvarez J, Scully R, Miller T, Armstrong FD, Constine LS, Friedman DL, et al. Long-term effects of treatments for childhood cancers. Curr Opin Pediatr 2007, 19: 23ｨC Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006, 355: 1572ｨC Lipshultz SE, Alvarez J, Scully R. Anthracyclines associated cardiotoxicity in survivors of childhood cancer. Heart 2008, 94: Lipshultz SE, Colan SD, Gelber RD, Perez-Atayde AR, Sallan SE, Sanders SP. Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med 1991, 324: 808ｨC Lipshultz SE, Lipsitz SR, Mone SM, Goorin AM, Sallan SE, Sanders SP, et al. Female sex and drug dose as risk factors for late cardiotoxic effects of doxorubicin therapy for childhood cancer. N Engl J Med 1995, 332: 1738ｨC Lipshultz SE, Lipsitz SR, Sallan SE, Dalton VM, Mone SM, Gelber RD, et al. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. J Clin Oncol 2005, 23: 2629ｨC Creutzig U, Diekamp S, Zimmermann M, Reinhardt D. Longitudinal evaluation of early and late anthracycline cardiotoxicity in children with AML. Pediatr Blood Cancer 2007, 15: Cox CL, Rai SN, Rosenthal D, Phipps S, Hudson MM. Subclinical late cardiac toxicity in childhood cancer survivors: impact on self-reported health. Cancer 2008, 112: Grenier MA, Lipshultz SE. Epidemiology of anthracycline cardiotoxicity in children and adults. Semin Oncol 1998, 25: 72ｨC Giantris A, Abdurrahman L, Hinkle A, Asselin B, Lipshultz SE. Anthracycline-induced cardiotoxicity in children and young adults. Crit Rev Oncol Hematol 1998, 27: 53ｨC Simbre VC, Duffy SA, Dadlani GH, Miller TL, Lipshultz SE. Cardiotoxicity of cancer chemotherapy: implications for children. Paediatr Drugs 2005, 7: 187ｨC Barry E, Alvarez JA, Scully RE, Miller TL, Lipshultz SE. Anthracycline-induced cardiotoxicity: course, pathophysiology, prevention and management. Expert Opin Pharmacother 2007, 8: 1039ｨC 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: 1544ｨC Maeda K, Tsutamoto T, Wada A, et al. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular and diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 1998, 135: 825ｨC Maisel AS. B-type natriuretic peptide (BNP) levels: Diagnostic and therapeutic potential. Rev Cardiovasc Med 2001, 2: S13ｨC8.

7 ｧ8 B ﾌ066ﾑ8I ﾌ08 6ﾑ8 ﾞ04 ﾌ6ｾ4, 21, McCullough PA, Omland T, Maisel AS. B-type natriuretic peptides: A diagnostic breakthrough for clinicians. Rev Cardiovasc Med 2003, 4: 72ｨC AML Collaborative Group. A systemic collaborative overview of randomized trials comparing idarubicin with daunorubicin (or other anthracyclines) as induction therapy for acute myeloid leukemia. AML Collaborative Group. Br J Haematol 1998, 103: Henry WL, Gardin JM, Ware JH. Echocardiographic measurements in normal subjects from infancy to old age. Circulation1980, 62: 1054ｨC Adams MJ, Lipshultz SE. Pathophysiology of anthracyclineand radiation-associated cardiomyopathies: implications for screening and prevention. Pediatr Blood Cancer 2005, 44: 600ｨC Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, et al. ASCO Cancer Survivorship Expert Panel. A- merican Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007, 25: 3991ｨC Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med. 1998, 339: 321ｨC Baughman KL. B-type natriuretic peptide-a window to the heart. N Engl J Med 2002, 347: 158ｨC Mir TS, Marohn S, Laer S, et al. Plasma concentration of N terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure. Pediatrics 2002, 110: 76ｨC Kawamura T, Wago M, Kawaguchi H, et al. Plasma brain natriuretic peptide concentrations in patients with Kawasaki disease. Pediatr Int 2000, 42: 241ｨC Hayakawa H, Komada Y, Hirayama M, Hori H, Ito M, Sakurai M. Plasma levels of natriuretic peptides in relation to doxorubicin-induced cardiotoxicity and cardiac function in children with cancer. Med Pediatr Oncol 2001, 37: Ekstein S, Nir A, Rein A, Perles Z, Bar-Oz B, Salpeter L, et al. N-terminal-proB-Type Natriuretic Peptide as a marker for acute anthracyclines cardiotoxicity in children. J Pediatr Hematol Oncol 2007, 29: Lipshultz SE, Colan SD. Cardiovascular trials in long-term survivors of childhood cancer. J Clin Oncol 2004, 22: 769ｨC Lipshultz SE, Giantris AL, Lipsitz SR, Kimball Dalton V, Asselin BL, Barr RD, et al. Doxorubicin administration by continuous infusion is not cardioprotective: the Dana- Farber acute lymphoblastic leukemia protocol. J Clin Oncol 2002, 20: 1677ｨC Levitt GA, Dorup I, Sorensen K, Sullivan I. Does anthracycline administration by infusion in children affect late cardiotoxicity? Br J Haematol 2004, 124: 463ｨC Dodos F, Halbsguth T, Erdmann E, Hoppe UC. Usefulness of myocardial performance index and biochemical markers for early detection of anthracycline-induced cardiotoxicity in adults. Clin Res Cardiol 2008, 97: Bryant J, Picot J, Baxter L, Levitt G, Sullivan I, Clegg A. Use of cardiac markers to assess the toxic effects of anthracyclines given to children with cancer: a systematic review. Eur J Cancer 2007, 43: ﾞｧ9 : ﾞ. ｦｧ9 090ｹ0 6ｾ402. ﾒ0ｸｧ , ｧ90209 ｦ 0903.: , Fax: atragian@hotmail.com, atriagia@auth.gr Correspondence auth08r: A. Tragiannidis 1, St. Kyirakidi , Thessaloniki Tel.: ｦ , Fax: atragian@hotmail.com, atriagia@auth.gr

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