title: Utility of routine left ventricular ejection fraction measurement before anthracycline-based chemotherapy in patients with diffuse large B-cell lymphoma.
abstract: OBJECTIVE
  Despite the lack of evidence, routine left ventricular ejection fraction (LVEF) measurement in diffuse large B-cell lymphoma (DLBCL) before anthracycline-based chemotherapy (ABC) is recommended by practice guidelines and required in DLBCL trials in the United States.
  
  
  METHODS
  We determined the frequency of the following in 197 consecutive patients with newly diagnosed DLBCL treated at our institution: one, LVEF measurement before ABC; two, finding of asymptomatic LV dysfunction (ALVD); and three, modification in treatment strategy as a result of LVEF measurement.
  
  
  RESULTS
  The median age was 71 years, and 54% of patients were men. LVEF was measured in 128 patients (65%) pretreatment, including in 15 with prior congestive heart failure (CHF). The reasons for not measuring LVEF were: clinically low risk for ALVD (n = 32), medical frailty (n = 15), palliative care (n = 3), ABC not standard therapy (n = 12), and prior CHF (n = 7). Among patients without prior CHF who had LVEF assessed (n = 113), ALVD was detected in four (4%), with LVEF ranging from 41% to 48%. Four patients were not treated despite normal LVEF because of comorbidities and anticipated toxicities. In contrast, all four patients with ALVD received ABC. No patient had a modification in treatment strategy as a result of LVEF measurement. After a median follow-up of 60 months, among those who remained alive, CHF developed in 15% versus 6% of patients receiving ABC who did and did not have LVEF measured, respectively (P = .246).
  
  
  CONCLUSIONS
  Our findings challenge the utility of routine LVEF measurement in patients with DLBCL before ABC. Potential cost savings to our health care system could be substantial.
authors.affiliation: Center for Cancer and Blood Disorders, Gundersen Lutheran Health System, 1900 South Ave, La Crosse, WI 54601, USA.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Conrad
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Gundrum
authors.forename: Vicki L
authors.initials: VL
authors.lastname: McHugh
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Go
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage* / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003657:Decision Making; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006333:Heart Failure / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D000069283:Rituximab; D013318:Stroke Volume / Q000502:physiology*; D019564:Unnecessary Procedures; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis*; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D018943:Anthracyclines; D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone