EARLY ASYMPTOMATIC DECLINE IN LEFT VENTRICULAR EJECTION FRACTION IN ADULT CANCER PATIENTS RECEIVING DOXORUBICIN
Left Ventricular Ejection in Cancer Patients
Keywords:Cardiotoxicity, Doxorubicin, Echocardiographic monitoring
Objective: To determine the frequency of doxorubicin induced early asymptomatic decline in left ventricular ejection fraction by serial echocardiography and to identify risk factors associated with cardiotoxicity.
Study Design: Quasi-experimental study.
Place and Duration of study: Oncology Department, Combined Military Hospital, Rawalpindi from January 2012 to December 2012.
Patients and Methods: Patients who were started on doxorubicin-based chemotherapy during the study period and had completed at least 300 mg/m2 cumulative dose were included in this study. Electrocardiography, chest X-ray and echocardiography were done at baseline and one to three months after completion of chemotherapy. All patients were evaluated for the presence of the following risk factors: pre-existing coronary artery disease, diabetes mellitus, hypertension, chest wall irradiation and a cumulative dose exceeding 400 mg/m2. Asymptomatic cardiac dysfunction was defined as ejection fraction (EF) fall greater than 10% on follow-up echocardiography with minimum or no symptoms.
Results: Significant change was observed in ejection fraction after completion of chemotherapy. Out of 54 patients, 27.8% showed 5%, 13% showed 10% decline, 16.7% had 15% decline, one (1.9%) patient had 20% decline in EF after completion of chemotherapy while 40.7% had no change in ejection fraction.
Conclusion: Thirty one percent of the patients developed ≥ 10% decline, in left ventricular ejection fraction with the use of doxorubicin in the cumulative dose range of 300-400 mg/m2. Pre-existing coronary artery disease, hypertension and a cumulative dose exceeding 400 mg/m2 are identifiable risk factors in this study. This entails regular monitoring for cardiac dysfunction by echocardiography during doxorubicin treatment.