Title: Cardiotoxicity of Doxorubicin –A Prospective Study
Authors: Jayaprakash Kesavapillai, S.Abdul Khader, Raju George, V.L.Jayaprakash, Raihanathul Misiriya
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.109
Abstract
Therapeutic strategy in malignancy involves use of various chemotherapeutic agents, radiation and surgery, either alone or in combination. Doxorubicin (Adriamycin) is a powerful drug in the fight against cancer. Cardiotoxicity is a major adverse effect of doxorubicin. Aim of the present study is to evaluate the profile of subacute and chronic cardiac toxicity of doxorubicin used for chemotherapy of various malignant neoplastic disorders. 100 consecutive patients referred to Cardiology Department for evaluation prior to chemotherapy with doxorubicin were enrolled in the study. Baseline and follow-up echocardiographic evaluation was carried out by two dimensional, M mode and Doppler assessment using standard transthoracic views. ECG was carefully examined for any arrhythmias, ST-T changes, conduction defects or other abnormalities. After completion of chemotherapy, patients were called for review for evaluation of cardiac status. Decline in ejection fraction after chemotherapy was observed in 39 patients, ranging up to 36% reduction compared to the baseline value. >10% decline in ejection fraction was observed in 19 patients and >15% reduction in 11 patients. The mean ejection fraction before chemotherapy was 73.95% and the mean value after treatment was 70.15%. The difference between these two was statistically significant (p=0.00039). Effect of adriamycin-based chemotherapy on Tei index was assessed. The mean value of Tei index showed no significant difference before and after treatment (0.45 vs. 0.48, p=NS). Electrocardiographic abnormalities like Brugada pattern (3% cases) and QTc prolongation (3% cases) were observed following administration of doxorubicin.
Keywords: Cardiotoxicity, Anthracycline, Echocardiography, Ejection fraction.
References
- Lefrak EA, Pitha J, Rosenheim S, Gottlieb JA. A clinicopathologic analysis of adriamycin cardiotoxicity. Cancer 1973; 32(2): 302-314.
- Sorensen K, Levitt G, Bull C, et al: Anthracycline dose in childhood acute lymphoblastic leukemia: Issues of early survival versus late cardiotoxicity. J Clin Oncol 1997; 15: 61-68,
- Steinherz LJ, Steinherz PG, Tan CT, Heller G, Murphy ML; Cardiac toxicity 4 to 20 years after completing anthracycline therapy. JAMA 1991; 266(12):1672-1677.
- S.M. et al. Congestive Heart Failure in Patients Treated with Doxorubicin-A Retrospective Analysis of Three Trials. Cancer 2003; 97: 2869–79.
- Von Hoff DD, Rozencweig M, Layard M, Slavik M, Muggia FM. Daunomycin-induced cardiotoxicity in children and adults. A review of 110 cases. Am J Med 1977; 62: 200-208.
- O, Le QH, Moullet I, Pauli E, Salles G, Espinouse D; Subclinical Late Cardiomyopathy After Doxorubicin Therapy for Lymphoma in Adults. J Clin Oncol 22(10):1864-1871.
- Kremer.L.C, van Dalen EC, Offringa M, Ottenkamp J, Voûte PA; Anthracycline-Induced Clinical Heart Failure in a Cohort of 607 Children: Long-Term Follow-Up Study. J Clin Oncol 2001; 19(1):191-196
- T, Tikanoja T, Riikonen P, Silvast A, Perkkiö M; Long-Term Prospective Follow-Up Study of Cardiac Function After Cardiotoxic Therapy for Malignancy in Children; J Clin Oncol 2003; 21(12):2349-2356.
- Ali MK, Soto A, Maroongroge D; Electrocardiographic changes after adriamycin chemotherapy. Cancer 1979; 43(2): 465-471.
- Friess GG, Boyd JF, Geer MR; Effects of first-dose doxorubicin on cardiac rhythm as evaluated by continuous 24-hour monitoring. Cancer 1985; 56: 2762-2764.
- Bristow M, Thompson P, Martin R; Early anthracycline cardiotoxicity. Am J Med 1978; 65: 823-832.
- Steinberg JS, Cohen AJ, Wasserman AG, Cohen P, Ross AM. Acute arrhythmogenicity of doxorubicin administration. Cancer 1987; 60: 1213-1218.