Cardiotoxicity of mitozantrone assessed by stress and resting nuclear ventriculography

The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

“…Overall, five studies 16 , 22 , 23 , 25 , 26 showed a benefit, five 18 , 19 , 24 , 27 , 28 showed possible benefit, and four 17 , 20 , 21 , 29 showed no benefit to utilizing cardiac stress tests in identifying evidence of cardiovascular disease in breast cancer survivors.…”

“…Heart function tests that were performed with stress in the selected studies were scintigraphy (n=5), 17 , 19 , 20 , 28 , 29 single photon emission computed tomography (SPECT) (n=4), 18 , 22 , 24 , 25 echocardiography (n=2), 16 , 23 cardiac magnetic resonance imaging (cMRI) (n=1), 21 nuclear ventriculography (n=1), 26 and ECG (n=5). 17 , 19 , 20 , 22 , 27 The utility of stress among each technique is shown in Figure 2A .…”

“…23 Stress ECG was utilized in five studies: one demonstrated a benefit, 22 although the benefit in this study was attributed to stress SPECT, not ECG; two demonstrated possible benefit, 19 , 27 and two no benefit. 17 , 20 Stress ventriculography was used in one study and demonstrated a benefit, compared to testing performed at rest; 26 while stress cMRI was also used in one study and failed to show a benefit, relative to resting imaging. 21 …”

“…Exercise was used to induce stress in eight studies, 17 – 20 , 23 , 25 , 27 , 29 pharmacological agents were used in five studies 16 , 21 , 22 , 24 , 25 and the cold pressor test in one study. 26 The utility of the use of exercise, pharmacological agents, or the cold pressor test to induce myocardial stress within the studies is displayed in Figure 2D . Exercise and pharmacological agents demonstrated a benefit or possible benefit in 63% and 80% of the studies they were used in to induce stress, respectively.…”

Ventricular Late Potentials in the Assessment of Mitoxantrone Cardiotoxicity

“…Though early animal studies sug gested that MTX was devoid of the progres sive cardiotoxic effects typical of anthracy clines [1][2][3], there have been several clinical reports of MTX cardiotoxicity in patients receiving multiple administrations [4][5][6]. Analyses of myocardial biopsy specimens have shown that a cardiomyopathy develops after multiple doses of this drug [7], The car diotoxicity of MTX is mild at total cumula tive doses < 100 mg/m2, and the cellular alterations induced are not severe except for patients receiving total cumulative doses > 200 mg/m2 [7], The latter show structural changes of the heart muscle qualitatively identical to those caused by anthracyclines, consisting of degeneration of myocytes and myofibrillar lysis [7], The presence of focal myopathic changes with a great quantity of fibrosis typical of these cardiomyopathies may give rise to an inhomogeneous propagation of conduction which is the electrophysiologic basis of lowamplitude high-frequency signals in the ter minal portion of the QRS complex and ST segment (late potentials, LP) [8,9], These low amplitude signals have been observed in patients with scarred myocardium and have been proposed as a marker of reentry which plays a major role in the pathophysiology of malignant ventricular arrhythmias [10,11].…”