Search

We measured cardiac performance sequentially, using quantitative radionuclide angiocardiography to estimate left ventricular ejection fraction in 55 patients receiving doxorubicin for treatment of cancer. With final doxorubicin dosages greater than 350 mg per square meter, the lowest ejection fraction measured was significantly less than the initial determination. Five patients had severe cardiotoxicity (congestive heart failure). All had an ejection fraction of less than 30 per cent at the time of heart failure, and demonstrated moderate cardiotoxicity (a decline in ejection fraction by at least 15 per cent to a final value of less than 45 per cent) before clinical manifestations. Six patients with moderate toxicity in whom doxorubicin was discontinued did not have heart failure or a further decline in ejection fraction during the follow-up period. Moderate toxicity was continued, but mild toxicity (decline of ejection fraction by greater than 10 per cent, noted in 11 patients) was not well predicted. The assessment of radionuclide left ventricular ejection fraction during doxorubicin therapy may make it possible to avoid congestive heart failure.

To assess the clinical and prognostic importance of the early appearance of a functional left ventricular aneurysm after myocardial infarction, we used equilibrium radionuclide angiocardiography to study 51 patients with an initial anterior infarction. A functional aneurysm was defined as an area of systolic akinesis or dyskinesis with a distinct diastolic deformity and preserved adjacent wall motion. Functional aneurysms developed in 18 patients (Group 1). Left ventricular ejection fraction was comparable in this group and in the 33 patients without aneurysm (Group 2) (27.3 +/- 10 vs. 31.4 +/- 12 per cent). One-year mortality was markedly different, with 11 deaths (61 per cent) in Group 1 and 3 (9 per cent) in Group 2 (P less than 0.001). Six (55 per cent) of the deaths in Group 1 were sudden. Patients with a functional aneurysm appearing within 48 hours had the highest risk of dying (8 of 10). Thus, early formation of a functional aneurysm occurs frequently after anterior myocardial infarction and carries a high risk of death within one year that is independent of ejection fraction. In addition, the absence of a functional aneurysm identifies a large group with a low one-year mortality despite a markedly impaired ejection fraction.