Concomitant Impairment of Left Ventricular Systolic and Diastolic Function During Doxorubicin Therapy: A Prospective Radionuclide Ventriculographic and Echocardiographic Study

Thirty adult lymphoma patients were studied prospectively with serial radionuclide ventriculography (RVG) and echocardiography (ECHO) to investigate whether changes in left ventricular (LV) diastolic function precede the impairment of LV systolic function during doxorubicin therapy. The patients received 8-10 cycles of CHOP to a cumulative doxorubicin dose of 400-500 mg/m2. RVG and ECHO were performed at baseline and after cumulative doxorubicin doses of 200, 400 and 500 mg/m2. Left ventricular ejection fraction (LVEF) decreased from 58 +/- 1.3 to 49.6 +/- 1.7% (p < 0.001) and from 58 +/- 1.7 to 52.5 +/- 1.3% (p = 0.036) as assessed with RVG and 2D ECHO, respectively. Of the diastolic ECHO doppler indices peak E wave velocity decreased from 63.3 +/- 3.2 to 51.3 +/- 2.6 cm/s (p = 0.008) and LV filling during the first 1/3 of diastole (1/3FF) from 42.2 +/- 1.7 to 36.5 +/- 2.0% (p < 0.001). The decrease in LVEF was statistically significant after the cumulative doxorubicin dose of 200 mg/m2 as assessed with RVG and after 400 mg/m2 as assessed with 2D ECHO. The decrease in 1/3FF reached the statistical significance after the cumulative doxorubicin dose of 400 mg/m2 and the decrease in peak E wave velocity after 500 mg/m2. This study shows that during doxorubicin therapy there are significant changes both in systolic and diastolic LV function. In addition, these changes manifest at relatively low cumulative doxorubicin doses and occur concomitantly. Thus, the assessment of diastolic function provides no advantage over monitoring systolic function during doxorubicin therapy.