This paper is only available as a PDF. To read, Please Download here.
Abstract
The relation between clinical evidence of and histologic signs of anthracycline cardiotoxicity
was evaluated by reviewing the clinical and morphologic findings in 64 patients studied
at necropsy, all of whom had received doxorubicin or daunorubicin chemotherapy during
life. Of the 64 patients, 20 (31%) had documented clinical toxicity consisting of
impaired left ventricular systolic performance; in 7 (35%) of these 20 patients, histologic
signs of toxicity were absent. In the remaining 13 patients with clinical toxicity,
histologic signs of toxicity ranged from mild to severe. Of the 44 (69%) patients
without clinical signs of drug toxicity, 21 (48%) had no histologic sign of cardiotoxicity;
in 23 (52%) of the patients without clinical toxicity, however, morphologic signs
of cardiotoxicity were nevertheless present—mild in most patients, but extensive in
4. Signs of extensive histologic toxicity (19 [30%] of 64 patients) were associated
with large doses (> 450 mg/m2) of the drug, mediastinal irradiation, and age > 70 years. This study suggests that
attempts to monitor cardiotoxicity by serial evaluation of cardiac histology in patients
undergoing anthracycline chemotherapy may be seriously limited by the fact that clinical
evidence of toxicity may be present without histologic signs of toxicity; likewise,
histologic signs of anthracycline toxicity may be present without clinical evidence
of toxicity.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The anthracycline antineoplastic drugs.N Engl J Med. 1981; 305: 139-153
- Risk factors for doxorubicin-induced congestive heart failure.Ann Intern Med. 1979; 91: 710-717
- Daunomycin-induced cardiotoxicity in children and adults. A review of 110 cases.Am J Med. 1977; 62: 200-206
- Doxorubicin cardiomyopathy: evaluation of phonocardiography, endomyocardial biopsy, and cardiac catheterization.Ann Intern Med. 1978; 88: 168-175
- A clinicopathologic analysis of Adriamycin cardiotoxicity.Cancer. 1973; 32: 302-314
- Cardiac ultrastructural changes induced by daunorubicin therapy.Cancer. 1973; 32: 771-788
- Adriamycin (NSC-123127) cardiotoxicity: a clinicopathologic correlation.Cancer Chermother Rep. 1975; 6: 215-225
- Relation of the weight of the heart to the weight of the body and of the weight of the heart to age.Am Heart J. 1928; 4: 79-93
- Daunomycin, an anti-tumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with specific reference to childhood leukemia.Cancer. 1967; 20: 333-353
- Rubidomycin in acute leukemia in adults.Br Med J. 1968; 3: 227-229
- Cardiac toxicity of daunorubicin.Lancet. 1969; 1: 837
- Damage to the intrinsic cardiac neurones by rubidomycin (daunorubicin).Br Heart J. 1969; 31: 607-609
- Daunomycin: a cardiotoxic agent.J Natl Med Assoc. 1971; 63: 261-267
- Clinical trials with Adriamycin.Cancer. 1971; 28: 844-850
- Adriamycin cardiotoxicity in man.Ann Intern Med. 1974; 81: 475-478
- Early onset of daunorubicin (Daunomycin) cardiotoxicity.Lancet. 1975; 2: 711-712
- Daunorubicin cardiotoxicity (letter).Lancet. 1976; 1: 430
- Pericarditis in a case of early daunorubicin cardiomyopathy.Ann Intern Med. 1976; 85: 339-341
- Early anthracycline cardiotoxicity.Am J Med. 1978; 65: 823-832
- Adriamycin. A new anticancer drug with significant clinical activity.Ann Intern Med. 1974; 80: 249-250
- Adriamycin (NSC-123127) cardiomyopathy: an overview with determination of risk factors.Cancer Chemother Rep. 1975; 6: 195-201
- Invasive and noninvasive methods of assessing adriamycin cardiotoxic effects in man: superiority of histopathologic assessment using endomyocardial biopsy.Cancer Treat Rep. 1978; 62: 857-864
- Noninvasive profile in the prospective monitoring of Adriamycin cardiomyopathy.Cancer Treat Rep. 1978; 62: 881-886
- Systolic time intervals in monitoring for anthracycline cardiomyopathy in pediatric patients.Cancer Treat Rep. 1978; 62: 907-910
- Serial studies of cardiac function in patients receiving Adriamycin.Cancer Treat Rep. 1978; 62: 923-929
- Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography.N Engl J Med. 1978; 300: 278-283
- Anthracycline cardiomyopathy monitored by morphologic changes.Cancer Treat Rep. 1978; 62: 865-872
- Comparison of amount of myocardial cell disorganization in operatively excised septectomy specimens with amount observed at necropsy in 18 patients with hypertrophic cardiomyopathy.Am J Cardiol. 1980; 46: 42-47
- Myocardial biopsy: a useful diagnostic procedure or only a research tool?.Am J Cardiol. 1978; 41: 965-967
- Late, late doxorubicin cardiotoxicity.Chest. 1980; 78: 880-882
- Doxorubicin cardiotoxicity: assessment of late left ventricular dysfunction by radionuclide cineangiography.Ann Intern Med. 1981; 94: 430-435
- Delayed and progressive myocardial lesions after Adriamycin administration in the rabbit.Cancer Res. 1976; 36: 2958-2966
- Dose-effect and structure-function relationships in doxorubicin cardiomyopathy.Am Heart J. 1981; 102: 709-718
- Systemic ventricular function in patients with tetralogy of Fallot, ventricular septal defect and transposition of the great arteries repaired during infancy.Circulation. 1981; 64: 878-885
- QRS voltage change with Adriamycin administration.Cancer Treat Rep. 1978; 62: 931-934
- A paucity of chronic electrocardiographic changes with Adriamycin therapy.J Electrocardiog. 1978; 11: 233-238
- Cardiac atrophy is a frequent etiology for the electrocardiographic finding of low voltage (abstr).Circulation. 1982; 66: II-127
- Adriamycin cardiotoxicity: endomyocardial biopsy evidence of enhancement by irradiation.Am J Surg Pathol. 1977; 1: 17-23
Article info
Publication history
Accepted:
January 6,
1983
Received:
January 5,
1983
Identification
Copyright
© 1983 Published by Elsevier Inc.
