Anthracycline cardiotoxicity: clinical and pathologic outcomes assessed by radionuclide ejection fraction.
A clinical syndrome of severe cardiomyopathy often accompanies administration of high doses of anthracycline agents. We studied 36 patients serially with radionuclide angiography. At three weeks following drug administration, 8 of 36 patients showed depression of ejection fraction (EF). All had received at least 280 mg/m2 of the drug and 7 had received more than 380 mg/M2. Definite clinical syndromes of congestive cardiomyopathy developed only in patients showing EF depression and in some patients, EF depression developed without signs of congestive heart failure. Ejection fraction studies at 5 minutes, 1 hour, 4 hours, 24 hours, 72 hours, and one week following drug administration showed no changes when compared to immediate preg-drug EF. Seven patients who died during the study underwent histologic examination. Only the single patient with a depressed EF showed histologic evidence of athracycline cardiotoxicity, although all but 1 of these patients had received at least 400 mg/M2. We conclude that serial radionuclide EF just prior to anthracycline administration is a potentially useful predictor of cardiac toxicity, and that EF depression and/or preservation of a normal EF should be weighed in the decision for administering a drug of this type at high dosage levels.
D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D003864:Depression, Chemical; D006027:Glycosides / Q000009:adverse effects; D006321:Heart / Q000187:drug effects; D006333:Heart Failure / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D009206:Myocardium / Q000648:ultrastructure; D009279:Naphthacenes / Q000009:adverse effects*; D011379:Prognosis; D011877:Radionuclide Imaging; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors
D000903:Antibiotics, Antineoplastic; D006027:Glycosides; D009279:Naphthacenes