Early asymptomatic decline in left ventricular ejection fraction in adult cancer patients receiving doxorubicin

ABSTRACT

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. Quasi-experimental study. Oncology Department, Combined Military Hospital, Rawalpindi from January 2012 to December 2012. Patients who were started on doxorubicin-based chemotherapy during the study period and had completed at least 300 mg/m[2] 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/m[2]. Asymptomatic cardiac dysfunction was defined as ejection fraction [EF] fall greater than 10% on follow-up echocardiography with minimum or no symptoms. 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. 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/m[2]. Pre-existing coronary artery disease, hypertension and a cumulative dose exceeding 400 mg/m[2] are identifiable risk factors in this study. This entails regular monitoring for cardiac dysfunction by echocardiography during doxorubicin treatment