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Non-Invasive Functional and Biochemical Assessment of Mitoxantrone Cardiotoxicity in Patients with Multiple Sclerosis

2003; Lippincott Williams & Wilkins; Volume: 42; Issue: 5 Linguagem: Inglês

10.1097/00005344-200311000-00015

1533-4023

Matthias Spindler, F. X. Weilbach, Meinrad Beer, J Sandstede, Herbert Köstler, J STROTMANN, Wolfram Voelker, Dietbert Hahn, Georg Ertl, Ralf Gold,

Advanced MRI Techniques and Applications

As mitoxantrone is a recently approved immunosuppressant for managing multiple sclerosis, the number of patients treated with this effective but potentially cardiotoxic anthracenedione derivative will increase substantially. To detect subclinical mitoxantrone-induced cardiotoxicity, sensitive non-invasive diagnostic tools are required. Assuming that changes in myocardial high-energy phosphate metabolism and alterations in left ventricular (LV) diastolic performance might be early markers of mitoxantrone-induced cardiotoxicity we examined fifteen MS patients treated with mitoxantrone up to 100 mg/m2 compared with 15 matched control MS patients. 31P-magnetic resonance (MR) spectroscopy was employed to measure myocardial high-energy phosphate metabolism, MR imaging for morphometric evaluation of changes in LV geometry. Indices of diastolic performance were assessed by Doppler echocardiography. In this exploratory study, phosphocreatine/ATP ratios were comparable between mitoxantrone-treated and control patients (1.48 ± 0.23 and 1.43 ± 0.41). LV mass, LV end-diastolic and systolic volumes, wall motion score, EF and cardiac output did not differ between both groups. All parameters of diastolic performance (E/A-ratio, isovolumic relaxation time, and E-wave deceleration time) were not different and within normal limits. In conclusion, using advanced diagnostic methodology, including functional, morphometric, and biochemical measurements no cardiotoxic effect of mitoxantrone up to a cumulative dose range of 100 mg/m2 could be detected.