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.