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Doxorubicin Cardiomyopathy: Evaluation by Phonocardiography, Endomyocardial Biopsy, and Cardiac Catheterization

MICHAEL R. BRISTOW, M.D., Ph.D.; JAY W. MASON, M.D.; MARGARET E. BILLINGHAM, M.D.; and JOHN R. DANIELS, M.D.
[+] Article and Author Information

Grant support: by Adria Laboratories, Inc., Wilmington, Delaware, and National Cancer Institute Grant CA 05838.

▸Requests for reprints should be addressed to Michael R. Bristow, M.D.; Division of Oncology, S-025, Stanford University Hospital; Stanford, CA 94305.


Stanford, California


© 1978 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1978;88(2):168-175. doi:10.7326/0003-4819-88-2-168
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Right ventricular endomyocardial biopsy, right heart catheterization, and systolic time intervals were done in 33 adult patients receiving doxorubicin (Adriamycin). Doxorubicin administration was associated with a doserelated increase in the degree of myocyte damage, and 27 of 29 patients biopsied at doses ≥ 240 mg/m2 had doxorubicin-associated degenerative changes identified on biopsy. The pre-ejection period to left ventricular ejection time ratio (PEP/LVET) showed a threshold phenomenon and did not begin to increase until a total dose of 400 mg/m2 had been reached. Seven patients with catheterization-proven heart failure had a significantly greater amount of myocyte damage on biopsy than dose-matched control subjects (P < 0.01). Previous mediastinal radiation appeared to potentiate the doxorubicin-associated degenerative process. Mediastinal radiation and age ≥ 70 years appeared to be risk factors for doxorubicin-associated heart failure. Dose limitation by combined clinical, noninvasive, invasive, and morphologic criteria offered an advantage over empirical dose limitation or dose limitation by PEP/LVET alone.

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