Echocardiography Identifies Changes in Left Ventricular Cardiac Function after Low Doses of Anthracycline, Particularly in Older Patients.

Anthracyclines remain an essential component of treatment regimes for lymphoma. Increasing numbers of older patients are being offered potentially curative treatment for lymphoma and a corresponding increase in cases of cardiac toxicity might be expected. Upper limits for total doses of anthracycline are published, but there is little information on whether age predicts independently for cardiac susceptibility to anthracyclines. There is also little data on the effect of low doses of anthracycline on the heart. We have prospectively studied cardiac function in patients receiving Doxorubicin (DOX) for High Grade Non Hodgkin’s Lymphoma and Hodgkin’s disease. 28 patients are included: 18 male, 9 female aged 16 to 89 (median 59) years. Echocardiographic examinations were undertaken before and after patients received DOX at a median dose of 85 mg/m² (50 mg/m² to 150 mg/m²). The Left Ventricular (LV) Tei index was calculated in all cases as the sum of the isovolumetric contraction time and isovolumetric relaxation time divided by the ejection time. Higher values represent cardiac dysfunction and a rise post treatment was regarded as deterioration in LV function. For the group, there was a significant post treatment deterioration in LV function as measured by the Tei index: 0.400 ± 0.12 pre-treatment to 0.475 ± 0.16 post treatment (P = 0.0076). Multivariate analysis of age, pre-treatment Tei index and DOX dose (in this low range) revealed age to be the only significant predictor of deterioration in cardiac function after treatment (correlation coefficient 0.69, p < 0.0001).

We conclude that measurable changes in cardiac function occur after very low doses of DOX and that these changes are more marked in older patients. Whether these changes will predict for further deterioration after higher doses of DOX and potentially predict for long term symptomatic cardiac dysfunction post therapy will require further study and follow up.