[Monitoring of Myocardial function during therapy with cardiotoxic cytostatics. Studies with the example of anthracycline-containing chemotherapy].

UNLABELLED

It is the purpose of this paper to show a concept of non-invasive assessment of cardiomyopathy (CM) in cytostatic treatment, especially with Docorubicin (A). In a follow-up study during therapy with A 150 patients were examined by ECG (QRS-amplitude), by systolic time intervals (STI), preejection period versus left ventricular ejection time (PEP/LVET), normal value greater than or equal to 0.45, and PEP corrected to 0-frequency (PEPc), normal value greater than or equal to 147 ms, by echocardiography (UCG), shortening fractions (SF), normal value greater than 30%, and in 6 cases by micro-catheter with exercise test.

RESULTS

(1) ECG does not predict CM (2) 11 patients (7%) had abnormal SF in UCG, 5 having symptoms of CM. 6 patients without clinical signs of CM were examined by microcatheter, 5 having abnormal pressure or HbO2 in the pulmonary artery at exercise. So nearly all patients with abnormal SF had objective signs of latent or overt CM (3) PEP/LVET was abnormal in all patients with CM but false positive in 44% of all investigations, mostly by shortening of LVET. PEPc, also abnormal in all patients with CM, was false positive only in 12%.

CONCLUSION

UCG is the most specific non-invasive method for assessment of CM in cytostatic treatment. STI are less specific but highly sensitive to CM and therefore a useful screening method. PEPc allows better selection than PEP/LVET because of its higher specificity. STI- contrary to UCG- can easily be obtained outside cardiologic centers, i.e. in the oncologic department itself, so that UCG is needed only in about 15-20% in treatment of patients. Cardiotoxic treatment should be stopped, when all values are abnormal, even when patients are asymptomatic. Since we adopted this policy we did not loose any of our last 100 patients from CM.