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Fungsi sistolik dan diastolik jantung pada pasien anak dengan osteosarkoma yang mendapat terapi doksorubisin di RS Cipto Mangunkusumo = Systolic and diastolic heart function in children with osteosarcoma after received doxorubicin at dr. Cipto Mangunkusumo Hospital

Latar belakang: Doksorubisin merupakan obat golongan antrasiklin yang penting dan efektif pada pengobatan tumor padat pada anak. Doksorubisin mencegah sintesis RNA dan DNA melalui proses interkalasi. Kardiotoksisitas dilaporkan paling banyak karena penggunaan doksorubisin tersebut, sehingga penggunaannya masih terbatas. Penelitian ini bertujuan untuk mengetahui fungsi jantung pada anak dengan osteosarkoma setelah mendapat terapi doksorubisin di RSCM. Metode: Penelitian ini merupakan studi deskriptif potong lintang yang dilakukan di RSCM dengan menelusuri catatan registrasi dan rekam medis pasien anak dengan osteosarkoma di Divisi Hematologi-Onkologi IKA dan di sub bagian Onkologi Orthopedik dan Traumatologi, sejak 1 Januari 2005 sampai 31 Desember 2012. Hasil: Dari 25 subjek penelitian, 21 pasien selesai menjalani kemoterapi dan mendapat total dosis kumulatif doksorubisin dengan rentang 300 mg/m 2 sampai 675 mg/m . Fungsi sistolik LV mengalami penurunan rerata fraksi ejeksi 3,3% dan fraksi pemendekan 2,5% setelah mendapat doksorubisin. Fungsi diastolik LV mengalami penurunan rerata rasio E/A 17,6%. Sembilan dari 18 pasien yang selesai menjalani kemoterapi dan mendapat total dosis kumulatif doksorubisin 375 mg/m 2 mengalami gangguan fungsi diastolik tidak disertai gangguan fungsi sistolik. Kardiomiopati dilatasi ditemukan pada satu pasien setelah mendapat dosis kumulatif doksorubisin 300 mg/m 2 dan satu pasien setelah mendapat dosis kumulatif doksorubisin 675 mg/m 2 . Pasien berusia ≥10 tahun dan berjenis kelamin perempuan lebih banyak mengalami penurunan fungsi sistolik dan diastolik LV setelah mendapat doksorubisin. Simpulan: Fungsi sistolik dan diastolik LV menurun setelah pasien mendapat terapi doksorubisin dengan dosis kumulatif 300 mg/m 2 . Penurunan fungsi diastolik mendahului penurunan fungsi sistolik LV. Dosis, usia, dan jenis kelamin perempuan dapat menjadi faktor risiko penurunan fungsi jantung setelah pemberian doksorubisin.
Kata kunci: Fraksi ejeksi, fraksi pemendekan, rasio E/A, osteosarkoma, doksorubisin.


Background: Doxorubicin is an anthracycline drug that is important and effective in the treatment of solid tumors in children. Doxorubicin inhibits RNA dan DNA synthesis by intercalation. The highest risk of cardiotoxicity is associated wit h doxorubicin administration that cause its use is limited. The aim of this study is to evaluate the cardiac function in children with osteosarcoma after received doxorubicin at dr. Cipto Mangunkusumo Hospital. Method: This descriptive cross-sectional study was done at RSCM by reviewing data at The Hematology Oncology Pediatrics Division and Sub Division of Oncology Orthopedic and Traumatology, since January 1, 2005 until December 31, 2012. Results: Out of 25 subjects, there were 21 subjects had finished the chemotherapy and received total cumulative dose of doxorubicin with range of 300 mg/m 2 up to 675 mg/m . Left ventricular systolic function had deteriorated with ejection fraction decreased 3.3% and shortening fraction decreased 2.5% after received doxorubicin. Left ventricular diastolic function had deteriorated with E/A ratio decreased 17.6%. Nine of 18 subjects who had finished chemotherapy and received doxorubicin total cumulative dose of 375 mg/m had diastolic function impairment without systolic function impairment. Dilated cardiomyopathy was found in 1 subject who received total cumulative dose of 300 mg/m 2 and 1 subject who received total cumulative dose of 675 mg/m 2 . Left ventricular systolic and diastolic function had decreased more common in subjects aged ≥10 year old and female sex after received doxorubicin. Conclusion: Left ventricular systolic and diastolic function had deteriorated after received doxorubicin total cumulative dose of 300 mg/m 2 . Left ventricular diastolic function deteriorated before systolic function. Dose, age and female sex possible became the risk factors of deteriorated the cardiac function after received doxorubicin.
Keywords: Ejection fraction, shortening fraction, E/A ratio, osteosarcoma, doxorubicin.