Early decline in left ventricular ejection fraction predicts doxorubicin cardiotoxicity in lymphoma patients

Abstract

Thirty adult patients with non-Hodgkin's lymphoma were studied to evaluate prospectively the significance of early decline in left ventricular ejection fraction after low cumulative doxorubicin dose (200 mg m 72 ) in predicting the later impairment of left ventricular function. Cardiac function was monitored with radionuclide ventriculography at baseline and after cumulative doxorubicin doses of 200, 400 and 500 mg m 72 . Cardiotoxicity was defined as a decrease in left ventricular ejection fraction of more than 10% units to a final left ventricular ejection fraction 450%. Twenty-eight patients received doxorubicin 5400 mg m 72 and were evaluable for cardiotoxicity. Clinical heart failure developed in two patients (7%) after a cumulative doxorubicin dose of 500 mg m 72 . Left ventricular ejection fraction decreased more than 10% absolute ejection fraction units to a final left ventricular ejection fraction 450% in 10 patients (36%). Left ventricular ejection fraction decreased from 56+1.5% to 53.6+1.5% (P=0.016) in patients with no cardiotoxicity, and from 60.8+2.4% to 41.8+2.0% (P50.001) in patients with cardiotoxicity. For patients who developed cardiotoxicity, the fall in left ventricular ejection fraction after a cumulative doxorubicin dose of only 200 mg m 72 was highly significant (left ventricular ejection fraction 49.7+1.8%, P=0.001 vs baseline). In receiver operator characteristic analysis, the area under the curve for the decrease in left ventricular ejection fraction at a cumulative doxorubicin dose of 200 mg m 72 for predicting cardiotoxicity in all patients was 0.858. The decrease in left ventricular ejection fraction of more than 4% units after a cumulative doxorubicin dose of 200 mg m 72 had a 90% sensitivity and 72% specificity for predicting later cardiotoxicity. Our results show that the significant impairment of left ventricular function during doxorubicin therapy can be predicted early, already at low cumulative doxorubicin doses. This finding may be of value in identifying patients at high or low risk for the development of anthracycline cardiotoxicity.

Aerobic Exercise Training as a Potential Cardioprotective Strategy to Attenuate Doxorubicin-Induced Cardiotoxicity

“…Retrospective analyses from clinical trials in adults suggest that the incidence of congestive heart failure due to DOX is 1 [14]. Clinical trials and animal studies showed that acute myocardial dysfunction occurring at the early phase of DOX treatment is highly predictive of later cardiomyopathy [16,17]. These studies further suggest that the chronic manifestations of DOXinduced cardiotoxicity may result from myocardial injuries associated with acute DOX exposure [18].…”

Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

“…27 Several studies have been published on cardiac monitoring to assess CTRCD, particularly with anthracyclines, the most frequently implicated agents. [28][29][30][31][32][33][34][35] There has been controversy as to the definition of CTRCD by using changes in resting LVEF, occurring during or after chemotherapy. The use of different LVEF cut-offs and methods of measurement (Teichholz, Simpson's biplane, or area-length method) have compromised the ability to compare results from different studies and collect evidence-based data.…”

The Framingham Risk Score Underestimates the Risk of Cardiovascular Events in the HER2-Positive Breast Cancer Population

“…Using the same guideline approach as that used for routine risk-stratification of patients with coronary artery disease, our patients were stratified into high-, intermediate-, and low-risk frs groups ( Figure 1). Cardiovascular outcomes of interest included cv events (heart failure-and cvd-related hospitalizations and deaths) and cardiotoxicity (lvef drop of >10% from baseline imaging to lvef of ≤50%) 14 .…”