Author + information
- Received July 30, 1984
- Revision received April 30, 1986
- Accepted May 8, 1986
- Published online November 1, 1986.
- ↵*Address for reprints: Arnold M. Strashun, MD, Andre Meyer Department of Physics-Nuclear Medicine, One Gustave Levy Place, Mount Sinai Medical Center, New York, New York 10029.
Serial gated blood pool scintigraphic monitoring of cardiac function with both a nonimaging scintillation probe and a conventional gamma camera-computer imaging system was performed in 101 patients receiving doxorubicin hydrochloride (Adriamycin) chemotherapy. Comparision of probe- and camera-derived ejection fractions (n = 287) correlated significantly (r = 0.70, p < 0.005) as did the interstudy (n = 183) change in ejection fraction (r = 0.76, p > 0.005). Significant discordance in probe- and camera-derived ejection fraction change occurred in 3 (1.6%) of 183 interstudy intervals. Average intrastudy variability of absolute probe-derived ejection fraction was 2.9%. This variability was unrelated to the level of cardiac function.
Thirteen patients (13%) developed clinical cardio-toxicity, including four at cumulative Adriamycin levels less than 450 mg/m2. Mean absolute camera ejection fraction decline for these patients was 21 % from baseline evaluation, and mean absolute probe ejection fraction decline was 22%. The minimal absolute ejection fraction decline was 11% for patients with clinical congestive heart failure. Eight asymptomatic patients had therapy terminated before the development of clinical cardio-toxicity after a mean decline in absolute camera ejection fraction of 19 ± 4% (SD) and in probe ejection fraction of 19 ± 9% into abnormal ranges (a decline in magnitude equivalent to that in patients developing congestive failure). None of these five asymptomatic patients available for clinical follow-up at 6 months after termination of Adriamycin therapy subsequently developed signs of ventricular dysfunction. The majority of patients (83%) studied at 450 mg/m2 cumulative dose levels did not have a 15% or greater decline from baseline into the abnormal range.
Thus, variability of a probe-derived ejection fraction measurement was similar to that derived from a conventional camera system and was within acceptable limits for characterization of clinical Adriamycin cardio-toxicity. The probe provides a less expensive alternative method for monitoring of Adriamycin toxicity with similar reliability to the more elaborate camera-computer system.
- Received July 30, 1984.
- Revision received April 30, 1986.
- Accepted May 8, 1986.
- American College of Cardiology Foundation