Recommended guidelines for monitoring patients are based on the patient’s cardiac function as measured by the left ventricular ejection fraction (LVEF): normal baseline LVEF ( 50%):
A second LVEF should be determined after administration of 250-300 mg/ml of anthracycline.
In patients with risk factors (heart disease, radiation, abnormal echocardiogram, cyclophosphamide), LVEF should be measured again at 400 mg/ml; in those with no risk factors, at 450 mg/ml.
Sequential studies should then be performed prior to each dose.
Treatment should be discontinued if the LVEF shows an absolute decrease of 10% or more or a decline to 50% or less.
Abnormal baseline LVEF (50% but 30%)
Sequential studies should be performed prior to each dose.
Treatment should be discontinued if the LVEF shows an absolute decrease of 10% or more and/or a final LVEF of 30% or less.
What is the most accurate method for detecting anthracycline-induced cardiac damage?
The most accurate method is endomyocardial biopsy. The main disadvantages of the biopsy are its invasive nature, limited availability, and expense.
How is anthracycline-induced cardiopathy treated?
Treatment of congestive heart failure or cardiomyopathy secondary to anthracyclines is with digoxin, diuretics, vasodilators, and/or captopril. Cardiac dysfunction can improve with standard therapy in some cases, as evidenced by improved long-term assessment.