Monitoring left ventricular function in adults receiving anthracycline‐containing chemotherapy

Abstract

Aims: To assess prospectively (1) the incidence of early anthracycline-induced cardiotoxicity; (2) the best predictor for identifying individuals at risk of developing functional cardiotoxicity; and (3) the most sensitive standard echocardiographic measure for the detection of anthracycline-induced changes in left ventricular (LV) function. Methods: Sixty-seven consecutive patients (45 male, mean age 50 ± 18 years) requiring doxorubicin-containing chemotherapy were enrolled. Clinical and echocardiographic assessments occurred before they received any anthracycline, after low-dose anthracyclines and 1-3 months after completion of their chemotherapy. Results: Twenty six percent of patients without significant pre-existing cardiac disease developed cardiotoxicity. The parameter that best predicted the development of functional cardiotoxicity was the change in EF between baseline and low dose with an area under the curve of 0.92. The Tei index detected declines in LV function earlier in the course of treatment with anthracyclines and to a greater significance than any other standard echocardiographic measurement but did not predict functional cardiotoxicity. Conclusions: All patients receiving potential cardiotoxic chemotherapy should be under the care of a cardiologist and have their EF monitored closely.

Rationale for and Preliminary Results of Proton Beam Therapy for Mediastinal Lymphoma

“…Mediastinal irradiation is known to cause both microvascular damage leading to ischemic necrosis and reparative fibrosis of the myocardium and macrovascular damage with atherosclerotic plaque formation leading to coronary artery disease, pericarditis, and valvular disease (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Modifications in radiation techniques resulting in lower radiation doses to the whole heart have made pericardial and myocardial disease less common.…”

“…Up to 50% of patients with lymphoma live long enough to experience life-threatening late effects of treatment. Radiation therapy contributes to some of these effects, particularly damage to the heart, with increased risk of premature coronary artery disease and valvular disease (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) and possible development of second malignancies of the lung, breast, and thyroid, with risks of 18% to 28% at 15-25 years (12)(13)(14)(15).…”

Valvular dysfunction and left ventricular changes in Hodgkin's lymphoma survivors. A longitudinal study

“…Anthracyclines are associated with dose-dependent cardiotoxicity, characterised by dilated cardiomyopathy and incipient heart failure (Singal and Iliskovic, 1998;Meinardi et al, 2000;Belham et al, 2007). The mechanisms underlying anthracycline-associated myocardial damage are undefined, but a potential mechanism may include enhanced apoptosis of cardiomyocytes (Meinardi et al, 2000;Wallace, 2003;Wouters et al, 2005).…”

Early Detection and Prediction of Cardiotoxicity - Biomarker and Echocardiographic Evaluation

“…In 67 consecutive patients on doxorubicin-containing chemotherapy, 26% of patients developed cardiotoxicity (Belham et al, 2007). The Tei-index detected declines in left ventricular function earlier in the course of anthracycline treatment and to a greater significance than others standard echocardiographic measurements but did not predict functional cardiotoxicity.…”