I-123 MIBG and serial radionuclide angiocardiography in doxorubicin-related cardiotoxicity.
In six patients with doxorubicin-related cardiotoxicity, the severity of decrease in left ventricle ejection fraction (LVEF) was associated with faster myocardial I-123 MIBG washout rates. In four patients with severely decreased LVEF (range 19% to 28%), the 4-hour washout rate varied from 43% to 56%. In two patients with moderate cardiotoxicity (LVEF 42% and 43%), the washout rates were 37% and 35%, respectively. In contrast, in another patient thought to have initial left ventricular dysfunction (LVEF dropped from 66% to 54%), the myocardial I-123 MIBG retention rate was not reduced (6% washout). Subsequent continuation of chemotherapy in this patient was without complication. Reduced I-123 MIBG uptake in the left ventricle generally correlated with areas with abnormal Fourier amplitude values, but in one of the patients with moderate cardiotoxicity, the I-123 MIBG uptake was not reduced in a region with loss of amplitude, indicating dysfunction but probably no myocardial denervation. Analysis of the regional myocardial retention in patients with cardiotoxicity showed no significant difference in the I-123 MIBG washout rates of both segments with or without loss of amplitude. These data suggest that in spite of a localized loss of ventricular function demonstrated by radionuclide angiocardiography, doxorubicin-related cardiotoxicity appears to be based on a global process of myocardial adrenergic derangement.
Valdés Olmos
R A
RA
Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam.
ten Bokkel Huinink
W W
WW
Greve
J C
JC
Hoefnagel
C A
CA
D019797:3-Iodobenzylguanidine; D000328:Adult; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology
D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019797:3-Iodobenzylguanidine; D004317:Doxorubicin