Abstract
Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease and in cardiomyopathy. The present study was undertaken to determine whether impaired diastolic function may be an early sign of anthracycline cardiotoxicity. Radionuclide left ventricular curves of 30 treated patients were compared with the curves of 17 normal, agematched, volunteers. The curves were analyzed for ejection fraction, peak filling rate (normalized for end diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first third of diastole normalized for cycle length. In 20 patients (Groups A and B), we analyzed the radionuclide ventriculography preceding the decrease of systolic function or a clinical congestive heart failure. In ten patients (Group C) who ended a treatment regimen without systolic dysfunction or clinically evident cardiotoxicity, we analyzed the ventriculography at the end of the therapy. Among the diastolic indexes, only the first third filling fraction was abnormal in a minority of the patients (6/20 in Groups A and B). Our findings suggest that diastolic dysfunction is uncommon in anthracycline treated patients prior to systolic dysfunction.
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References
Alexander J, Dainiak N, Berger HJ, Goldman L, Hohnstone D, Reduto L, Duffy T, Schwartz P, Gottschalk A, Zaret BL (1979) Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography. N Engl J Med 300:278–283
Bachur NR (1979) Anthracycline antibiotics: pharmacology and metabolism. Cancer Treat Rep 63:817–820
Bonfante V, Ferrari L, Brambilla C, Rossi A, Villani F, Crippa F, Valagussa P, Bonadonna G (1986) New anthracycline analogs in advanced breast cancer. Eur J Cancer Oncol 22:1379–1385
Bonow RO, Rosing DR, Bacharach SL, Green MV, Kent KM, Lipson LC, Maron BJ, Leon MB, Epstein SE (1981 a) Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy. Circulation 64:787–796
Bonow RO, Bacharach SL, Green MV, Kent KM, Rosing DR, Lipson LC, Leon MB, Epstein SE (1981 b) Impaired left ventricular diastolic filling in patients with coronary artery disease and assessment with radionuclide angiography. Circulation 64:315–323
Bourdillon PD, Lorell BH, Mirsky I, Paulus WJ, Wynne J, Grossman W (1983) Increased myocardial stiffness of the left ventricle during pacing induced angina in man. Circulation 67:316–323
Bristow MR, Billingham ME, Mason JW, Daniels JR (1978) Clinical spectrum of anthracycline antibiotic cardiotoxicity. Cancer Chemother Rep 6:195–201
Bristow MR, Mason JW, Billingham ME, Daniels JR (1981) Doseeffect and structure-function relationships in doxorubicin cardiomyopathy. Am Heart J 102:709–718
Carter SK (1975) Adriamycine: a review. J Natl Canc Inst 55:1265–1274
Choi BW, Berger HJ, Schwartz PE, Alexander J, Wackers FIT, Gottschalk A, Zaret BL (1983) Serial radionuclide assessment of doxorubicin cardiotoxicity in cancer patients with abnormal baseline resting left ventricular performance. Am Heart J 106:638–643
De Kock M, Melin JA, Nannan ME, Robert A, Beckers C, Lavenne F, Detry JMR (1986) Alteration of left ventricular diastolic filling in hypertensive patients: effects of nitrendipine and atenolol. Eur Heart J 7:792–799
Gottdiener JS, Mathisen DJ, Borer JS, Bonow RO, Myers CE, Barr LH, Schwartz DE, Bacharach SL, Green MV, Rosenberg SA (1981) Doxorubicin cardiotoxicity: assessment of late left ventricular dysfunction by radionuclide cine-angiography. Ann Intern Med 94:430–435
Inouye I, Massie B, Loge D, Topic N, Silverstein D, Simpson P, Tubau J (1984) Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension. Am J Cardiol 53:120–126
Jain KK, Casper ES, Geller NL, Hakes TB, Kaufman RJ, Currie V, Schwartz W, Cassidy C, Petroni GR, Young CW, Wittes RE (1985) A prospective randomized comparison of epirubicin and doxorubicin in patients with advanced breast cancer. J Clin Oncol 3:818–826
Lee BH, Goodenday LS, Muswick GJ, Yasnoff WA, Leighton RF, Skeel RT (1987) Alterations in left ventricular diastolic function with doxorubicin therapy. JACC 9:184–188
Maral RJ, Jouanne M (1981) Toxicology of daunorubicin in animals and man. Cancer Treat Rep 65:9–18
Minow RA, Benjamin RS, Lee ET, Gottlieb JA (1977) Adriamycin cardiomyopathy - risk factors. Cancer 39:1397–1402
Polak JF, Kemper AJ, Bianco JA, Parisi AF, Tow DE (1981) Resting early peak diastolic filling rate: a sensitive index of myocardial dysfunction in patients with coronary artery disease. J Nucl Med 23:471–478
Ritchie JL, Singer JW, Thorning D, Sorensen SG, Hamilton GW (1980) Anthracycline cardiotoxicity: clinical and pathologic outcomes assessed by radionuclide ejection fraction. Cancer 46:1109–1116
Singer JW, Narahara KA, Ritchie JL, Hamilton GW, Kennedy JW (1978) Time- and dose-dependent changes in ejection fraction determined by radionuclide angiography after anthracycline therapy. Cancer Treat Rep 62:945–948
Soufer R, Wohlgelernter D, Vita N (1985) Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol 55:1032–1036
Topol EJ, Tarill TA, Fortuin NJ (1985) Hypertensive hypertrophic cardiomyopathy of the elderly. N Engl J Med 312:277–283
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This study was supported in part by grant 3.4536.83 from the Fonds de la Recherche Scientifque Médicale and grant 83/88-51 from the Services de Programmation de la Politique Scientifique
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Parmentier, S., Melin, J.A., Piret, L. et al. Assessment of left ventricular diastolic function in patients receiving anthracycline therapy. Eur J Nucl Med 13, 563–567 (1988). https://doi.org/10.1007/BF02574768
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DOI: https://doi.org/10.1007/BF02574768