RISK FACTORS FOR CARDIAC DYSFUNCTION IN CHILDREN ON TREATMENT FOR CANCER AT KENYATTA NATIONAL HOSPITAL, NAIROBI

Abstract

Objective: To determine the point prevalence of abnormal cardiac function and to assessthe risk factors for cardiac dysfunction in paediatric oncology patients on treatmentat Kenyatta National Hospital.

Design: Descriptive cross-sectional study with a nested case control.

Setting: Kenyatta National Hospital between February and April 2006.

Main outcome measures: Left ventricular dysfunction if ejection fraction (EF) <55% orfractional shortening (FS) <29% defined cases. Controls had EF >55% or FS >29%.

Results: One hundred and eleven patients were enrolled of whom 32 had abnormalcardiac function and were classified as cases while 79 had normal cardiac function. Abouta third, point prevalence 29% (95% CI 21.2-37.9), had cardiac dysfunction. Cumulativeanthracycline dose was a risk factor for cardiac dysfunction in this population. Above200mg/m2 the attributable risk percentage of cardiac dysfunction was 77%.

Conclusions: Serial echocardiography should be performed to identify patients at risk.Alternative treatment protocols should be used when the cumulative anthracycline doseexceeds 200mg/m2 due to the high attributable risk. Studies to further assess the otherassociated risk factors and long term effects of anthracycline are recommended.