Radionuclide Methods in the Assessment of Anthracycline-Induced Cardiotoxicity

Purpose. To compare diagnostic efficacy of multigated acquisition (MUGA) scan and Tc-99m MIBI gated SPECT for evaluation and forecast of anthracycline-induced cardiotoxicity. Material and methods. We included into this study 80 patients (72 women and 8 men, mean age 43 +/- 4.2 years) with malignant tumors without overt pathology of the cardiovascular system. These patients received doxorubicin (50 mg/m(2) per course) based cytostatic therapy. All patients were studied either by MUGA (n=40) or Tc-99m MIBI gated SPECT (n=40) before initiation of chemotherapy 1 hour after first administration of doxorubicin and after the 4th course. Results. After administration of 50 mg/m(2) of doxorubicin 14 patients according to MUGA scan and 16 patients according to Tc-99m MIBI gated SPECT had significant (>= 10%) reduction of left ventricular ejection fraction (LVEF). Significant inhibition of systolic function in these patients remained after the 4th course of treatment. Individual analysis of the MUGA and Tc-99m MIBI gated SPECT data registered after the fourth course (achievement of total doxorubicin dose of 200 mg/m(2)) showed that >= 10% LVEF reduction in response to the first dose of doxorubicin could predict the development of cumulative cardiotoxicity. Conclusion. MUGA scan and Tc-99m MIBI gated SPECT can be applied with equal effectiveness for assessment of acute and chronic anthracycline-induced cardiotoxicity in patients with malignant tumors. LVEF reduction 10% in response to the first dose of doxorubicin appeared to be a predictor of development of chronic cardiotoxicity.