{"id":"d80f9a43525a","type":"article","url":"https://hartvaat.nl/2026/05/05/vroege-harttoxiciteit-na-doxorubicine-bij-jongvolwassenen-met-sarcoom/","title":"Vroege harttoxiciteit na doxorubicine bij jongvolwassenen met sarcoom","title_en":"Early anthracycline cardiotoxicity in adolescents and young adults with sarcoma: a prospective echocardiographic study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag143","source_url":"https://doi.org/10.1093/eschf/xvag143","authors":["Efstratios Koutroumpakis","Efthymios Triantafyllou","John Andrew Livingston","Juhee Song","Claire Viguet","Andres Hughes","Savannah V Rauschendorfer","Prince Jeyabal","Theresa A Honey","Joya Chandra","Najat C Daw","Michelle A T Hildebrandt","Jose Banchs","Susan C Gilchrist","Michael E Roth","Anita Deswal","Eugenie S Kleinerman"],"significance":5,"published":"2026-07-29","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/","https://hartvaat.nl/kennis/diagnostiek/speckle-tracking-strain/"],"congress":"","summary_en":"A prospective cohort study of 70 adolescents and young adults (15–39 years) with sarcoma receiving high-dose doxorubicin evaluated early echocardiographic changes. At one year, 44.4% met the primary endpoint, primarily driven by a decline in the LVWT/D ratio, with significant subclinical reductions in LVEF and global longitudinal strain also observed. Approximately half of these abnormalities persisted at two years, and one patient developed symptomatic heart failure. These findings highlight the need for routine echocardiographic and strain monitoring to detect subclinical cardiotoxicity early in this vulnerable population.","created":"2026-07-22T01:04:41Z","updated":"2026-08-10T10:38:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een prospectief cohortonderzoek bij 70 jongvolwassenen (15-39 jaar) met sarcoom die hoge doses doxorubicine ontvingen, werd vroege harttoxiciteit geëvalueerd met echocardiografie. Na één jaar voldeed 44,4% aan de primaire eindpuntcriteria, voornamelijk door een daling in de LVWT/D-verhouding; significante subklinische afnames in LVEF en longitudinale strain werden eveneens waargenomen. Deze veranderingen bleven bij de helft van de patiënten na twee jaar aanhouden. Voor de klinische praktijk benadrukt dit het belang van regelmatige echocardiografische controle en strainmetingen om subklinische cardiotoxiciteit vroegtijdig op te sporen bij deze kwetsbare groep.","abstract_original":"BACKGROUND: Adolescents and young adults (AYAs) with sarcomas often receive high-dose doxorubicin (Dox), but data on early cardiotoxicity in this population are limited. OBJECTIVES: To prospectively evaluate early echocardiographic changes in AYAs with sarcoma treated with high-dose Dox. METHODS: AYAs (15-39 years) with sarcoma treated at a tertiary cancer centre (2018-22) were prospectively enroled. Echocardiograms were performed at baseline, 1 and 2 years after cancer therapy initiation and interpreted by a single cardiologist. The primary endpoint was a >10% absolute reduction in left ventricular ejection fraction (LVEF), an absolute LVEF <50%, or >10% decrease in LV wall thickness/dimension (LVWT/D) ratio from baseline. Secondary endpoints included longitudinal changes in cardiac structure, chamber volumes, systolic and diastolic function, and strain. RESULTS: Of 70 patients, 56 completed at least two of three study echocardiograms (median age 22.6 [IQR, 17.6-30.5] years; 41% female, 84% white). Median cumulative Dox dose was 450 (IQR, 370-450) mg/m2; 75% received dexrazoxane. The primary endpoint was met by 44.4% at 1 year and 27.5% at 2 years, driven primarily by LVWT/D ratio decline (37% at 1 year, 25% at 2 years), while significant LVEF decline was observed in 11.1% and 2.5%, respectively. Significant absolute changes at 1 year included LVEF (-2.73 ± 4.3%, P < .001), global longitudinal strain magnitude (-1.37 ± 2.56%, P = .002), septal e' (-1.75 ± 2.48 cm/s, P < .001), and lateral e' (-2.78 ± 3.44 cm/s, P < .001), persisting at 2 years. One patient (1.8%) developed ventricular fibrillation and heart failure with reduced ejection fraction, with LVEF recovery within 1 year. CONCLUSIONS: Over one-third of AYAs with sarcoma met the primary endpoint at 1 year, with half of these abnormalities persisting at 2 years, primarily driven by LVWT/D ratio reductions. Subclinical changes in strain and diastolic function were observed, reflecting the broad cardiac impact of high-dose Dox in this population."}