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European Journal of Echocardiography 2003 4(4):300-305; doi:10.1016/S1525-2167(03)00017-9
© 2003 by European Society of Cardiology
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Copyright © 2003, The European Society of Cardiology

Repetitive Dobutamine Stress Echocardiography for the Prediction of Anthracycline Cardiotoxicity

M Bountioukos1, J.K. Doorduijn2, J.R.T.C. Roelandt1, E.C. Vourvouri1, J.J. Bax1, A.F.L. Schinkel1, M.D. Kertai1, P. Sonneveld3 and D. Poldermans1,*

1Thoraxcenter, Department of Cardiology, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
2Erasmus MC-Daniel den Hoed Oncologisch Centrum, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
3Erasmus MC-Centrumlocatie L 439, Rotterdam, The Netherlands

Received 18 December 2002; received in revised form 1 March 2003; accepted after revision 4 March 2003.

* Address correspondence to: Don Poldermans, Thoraxcenter Room Ba 300, Department of Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel: +31-10-4639222; Fax: +31-10-4634957. poldermans{at}hlkd.azr.nl


  Abstract

Aims: To evaluate whether repetitive assessment of systolic and diastolic cardiac function by dobutamine stress echocardiography (DSE) can predict anthracycline cardiotoxicity.

Methods and results: Thirty-one patients (age, 57±13 years, 22 male) were studied before chemotherapy, with follow-ups during, at the end, and 6 months after chemotherapy. Left ventricular (LV) function was assessed by two-dimensional (2D) echocardiographic wall motion score index (WMSI) and by Doppler echocardiography of mitral valve inflow at rest and during DSE. Radionuclide ventriculography was used as an independent reference for ejection fraction (EF). A reduction of EF ≥5% occurred in 17 patients (group A) at the last follow-up. Patients without decreased EF comprised group B. Early/late diastolic velocity of mitral inflow (E/A ratio) at rest was lower in group A (0.91±0.2 vs 1.28±0.3, P<0.001), and it was an independent predictor of cardiotoxicity (adjusted for baseline patient characteristics and parameters of systolic and diastolic function). At follow-up, WMSI at rest paralleled radionuclide EF. Contractile reserve at low-dose DSE was preserved in group A.

Conclusions: WMSI measured by 2D echocardiography parallels radionuclide EF at follow-up. Assessment of contractile reserve has no incremental value for the early detection of cardiotoxicity. A baseline abnormal E/A ratio is an independent predictor of anthracycline cardiotoxicity.

Keywords: anthracyclines; drug toxicity; dobutamine; echocardiography; Doppler


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