Early decline in left ventricular ejection fraction predicts doxorubicin cardiotoxicity in lymphoma patients

Thirty adult patients with non-Hodgkin's lymphoma were studied to evaluate prospectively the significance of early decline in left ventricular ejection fraction after low cumulative doxorubicin dose (200 mg m−2) in predicting the later impairment of left ventricular function. Cardiac function was monitored with radionuclide ventriculography at baseline and after cumulative doxorubicin doses of 200, 400 and 500 mg m−2. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction of more than 10% units to a final left ventricular ejection fraction ⩽50%. Twenty-eight patients received doxorubicin ⩾400 mg m−2 and were evaluable for cardiotoxicity. Clinical heart failure developed in two patients (7%) after a cumulative doxorubicin dose of 500 mg m−2. Left ventricular ejection fraction decreased more than 10% absolute ejection fraction units to a final left ventricular ejection fraction ⩽50% in 10 patients (36%). Left ventricular ejection fraction decreased from 56±1.5% to 53.6±1.5% (P=0.016) in patients with no cardiotoxicity, and from 60.8±2.4% to 41.8±2.0% (P