Noninvasive monitoring of adriamycin cardiotoxicity by "Sphygmo-Recording" of the pulse wave delay (QKd interval).

Eighty patients with Ewing's sarcoma, bronchogenic carcinoma, and other neoplasms receiving adriamycin were monitored by a Sphygmo-Recording of the pulse wave delay (QKd time interval). The QKd interval, which is the sum of the cardiac pre-ejection period and the pulse transmission time, is sensitive to changes in myocardial contractility and stroke output. The patients were also followed by serial physical examinations, electrocardiograms, chest roentgenograms, serum enzymes, and thyroid function tests; none of these changed during the study period except in a few patients with congestive heart failure (CHF) and/or transient arrhythmias. QKd showed a significant prolongation (greater than 30 msec) within 1-3 weeks after adriamycin administration in a high percentage of patients followed closely. The QKd interval usually returned to pretreatment baseline levels within 4-7 weeks after adriamycin administration. The QKd often showed repeated and sustained elevations after courses of therapy at 3-week intervals. After adriamycin therapy was discontinued the QKd usually returned to normal levels. No statistically significant changes in the QKd were seen in a control group. There were no acute changes in QKd during adriamycin infusions. Of seven patients receiving cumulative doses of adriamycin greater than 550 mg/m2, three developed CHF. QKd intervals in all three of these patients had failed to return to the baseline values 2-3 months prior to any other evidence of CHF. This suggests that failure of QKd to return to pretreatment baseline levels may be of prognostic value. The QKd interval appears to reflect a high incidence of subclinical adriamycin cardiotoxicity. The technique is simple, noninvasive, rapid, and potentially useful for monitoring patients receiving adriamycin and other potentially cardiotoxic drugs.