Circadian mesor of recumbent pulse--cost-effective predictor of doxorubicin-induced congestive heart failure.
Nineteen adult cancer patients each received 6-10 monthly treatments of doxorubicin and cisplatin. For 24-30 hr before each treatment, recumbent pulse was measured. Treatment was stopped for disease progression or when a total doxorubicin dose of 550 mg/m2 was reached. No patient developed congestive heart failure (CHF) during therapy. Two to four months after stopping treatment, three patients developed CHF. In these cases, 2-6 months before complication of therapy, prior to notable decrement in any other index of cardiac function, the 24-hr rhythm-qualified mean (mesor) of pulse showed a positive slope by linear regression analysis (P less than 0.05). This mesor rise was apparent at cumulative doxorubicin doses of 300, 420 and 240 mg/m2. patients subsequently received additional doxorubicin to total doses of 540, 525 and 530 mg/m2. Patients who did or did not experience a rise in pulse received similar total doses of doxorubicin. Serial pulse mesors predicted CHF reliably and were substantially less expensive than radionuclide ejection fraction determination ($200 per test). A progressive rise in the circadian pulse-mesor was clearly a harbinger of histologically documented doxorubicin-induced lethal CHF in Wistar-Kyoto rats of both sexes.
D000328:Adult; D000368:Aged; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002940:Circadian Rhythm; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects* / Q000633:toxicity; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods*; D009369:Neoplasms / Q000188:drug therapy; D011187:Posture; D051381:Rats; D011919:Rats, Inbred Strains; D013318:Stroke Volume
D004317:Doxorubicin; D002945:Cisplatin