SERIAL ASSESSMENT OF DOXORUBICIN CARDIOTOXICITY WITH QUANTITATIVE RADIONUCLIDE ANGIOCARDIOGRAPHY

We measured cardiac performance sequentially, using quantitative radionuclide angiocardiography to estimate left ventricular ejection fraction in 55 patients receiving doxorubicin for treatment of cancer. With final doxorubicin dosages >350 mg per square meter, the lowest ejection fraction measured was significantly less than the initial determination. Five patients had severe cardiotoxicity (congestive heart failure). All had an ejection fraction of <30 per cent at the time of heart failure, and demonstrated moderate cardiotoxicity (a decline in ejection fraction by at least 15 per cent to a final value of ≤45 per cent) before clinical manifestations. Six patients with moderate toxicity in whom doxorubicin was discontinued did not have heart failure or a further decline in ejection fraction during the follow-up period. Moderate toxicity was continued, but mild toxicity (decline of ejection fraction by >10 per cent, noted in 11 patients) was not well predicted. The assessment of radionuclide left ventricular ejection fraction during doxorubicin therapy may make it possible to avoid congestive heart failure. (N Engl J Med 300:278–283, 1979) DOXORUBICIN hydrochloride (adriamycin), an anthracycline antibiotic, is highly efficacious in the treatment of numerous cancers1; however, its efficacy is partly dependent upon high cumulative dosages. The clinical application of long-term doxorubicin therapy may be limited by the precipitous development of an often irreversible cardiomyopathy.1 2 3 4 5 6 Approximately one third of patients receiving high dosages of doxorubicin have been reported to have symptomatic congestive heart failure.2,5,6 This phenomenon has led to recommendations that the total cumulative dose of doxorubicin not exceed 550 mg per square meter of body-surface area and that even lower cumulative doses be employed in patients with underlying heart. © 1979, Massachusetts Medical Society. All rights reserved.