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Assessment of Left Ventricular Contractility in Patients Receiving Doxorubicin

KENNETH M. BOROW, M.D.; I. CRAIG HENDERSON, M.D.; ALEXANDER NEUMAN; STEVEN COLAN, M.D.; STAFFORD GRADY, M.D.; STEVEN PAPISH, M.D.; and ALLEN GOORIN, M.D.
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▸Requests for reprints should be addressed to Kenneth M. Borow, M.D.; Cardiovascular Division, Department of Medicine, The University of Chicago, 950 East 59th Street, Box 423; Chicago, IL 60637.


©1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;99(6):750-756. doi:10.7326/0003-4819-99-6-750
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The usual indices of left ventricular systolic performance have been incapable of accurately recognizing early myocardial impairment in many patients treated with doxorubicin. Recently, several new load-independent, highly sensitive indices of left ventricular contractility have been developed including the slope value of the endsystolic pressure (Pes)-dimension (Des) relation and the position of the left ventricular end-systolic wall stress (σ es)-percent fractional shortening (%ΔD) relation. We used these indices to study 46 patients receiving either low dose or high dose doxorubicin. Results were compared with data from 30 healthy subjects. Resting %ΔD failed to accurately recognize left ventricular dysfunction in 9 of 17 patients with low normal values. These patients had reduced afterload, as measured by σes, permitting normal extent of left ventricular fiber shortening despite impaired contractility as quantified by diminished Pes-Des slope values. There was 98% concordance between the relative position of the σes%ΔD relation and the slope value of the Pes-Des, relation. These indices offer an improved means of recognizing and quantitating impaired contractility in patients treated with doxorubicin.

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