Doxorubicin cardiotoxicity in children.

To characterize the long-term effects of doxorubicin hydrochloride (Adriamycin) on left ventricular function, a total of 588 echocardiograms were obtained prospectively in 46 children who were treated for malignancy. We found shortening fraction of the left ventricle to be more useful than systolic time intervals for detecting cardiotoxic effects. Abnormal cardiac function occurred in 43% of patients but only 4% developed congestive heart failure which was irreversible. There appeared to be strong individual variation in response to the effects of doxorubicin on the heart unrelated to treatment regimen, age of onset of treatment, or total cumulative dose. If the SF remained normal it was possible to give a dose greater than 550 mg/m2. If cardiac dysfunction occurred following cessation of doxorubicin, it did so within five months in 95% of patients. Discontinuing doxorubicin therapy in patients with SF LEss than 20% who did not have clinical signs of congestive heart failure resulted in improved shortening fraction and administration of digoxin did not further improve the SF. Sequential echographic evaluation of cardiac function at frequent intervals has proven to be useful during and following treatment with doxorubicin.