Paper of the ventriculography in patients treated with anthracycline

Aim: The aim of this study is to calculate the ejection fraction determined by radionuclide ventriculography in patients treated with anthracyclines, in order to find the dose of adriamycin that leads to cardiotoxicity. Materials and methods: We have reviewed the case histories of 28 patients from the Department of Oncology, with at least two radionuclide ventriculographies performed ( the second one after treatment with anthracyclines). Patients were 12 women and 16 men ranged in age from 16 and 72 years (mean 43, median 45 years) with different tumours: 39% sarcoma, 22% breast cancer and 22% non-Hodgkin lymphoma. We have calculated for each patient the total dose of anthracyclines received (adriamycin and epirubicin) including the anthracyclines received before the first radionuclide ventriculography (cumulative cardiotoxicity). The dose of epirubicin has been converted to the correspondent of adriamycin following the relation: 50mg/m2 of adrimycin is equivalent to 75 mg/m2, because of epirubicin is less cardiotoxic. Ejection fraction means before and after treatment were compared and the Student's t test was applied to determine whether there were significant differences. Results: Student's t test showed significant differences between left ventricle ejection fraction means before and after the treatment (t=4.08, p<0.01), but did not show differences between right ventricle ejection fraction means (t=1.79, p=0.09). We have calculated the total dose of anthracyclines in 25 patients. Only one the patients (n=10) that received a cumulative dose <300 mg/m2 suffered a significant decrease of the left ventricular ejection fraction. 75% of the patients that received a cumulative dose >300mg/m2 (n=15) suffered a decrease of the left ventricular ejection fraction >6%, and 40% of them suffered a significant decrease of the left ventricular ejection fraction (>10%). In 21.5% of the cases the chemotherapy protocol had to be changed due to the results obtained by radionuclide ventriculography. Conclusions: Radionuclide ventriculography changed the chemotherapy protocol in a significant percentage of patients. A clear relation exists between the anthracycline dose administered and the decrease of the ejection fraction. Adriamycin cumulative doses <300mg/m2 represent low risk of cardiotoxicity (Au)