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Myocardial function in patients with multiple sclerosis treated with low-dose mitoxantrone

2002; Elsevier BV; Volume: 89; Issue: 10 Linguagem: Inglês

10.1016/s0002-9149(02)02312-3

1879-1913

J STROTMANN, Matthias Spindler, F. X. Weilbach, Ralf Gold, Georg Ertl, Wolfram Voelker,

Chemotherapy-induced cardiotoxicity and mitigation

Although there is increasing evidence for the beneficial effect of mitoxantrone in the treatment of patients with multiple sclerosis (MS), there is controversy concerning the potential cardiotoxic effects of low-dose mitoxantrone therapy. 1 Noseworthy J.H. Gold R. Hartung H.P. Treatment of multiple sclerosis recent trials and future perspectives. Curr Opin Neurol. 1999; 12: 179-293 Crossref Scopus (68) Google Scholar , 2 Millefiorini E. Gasperini C. Pozzilli C. D'Andrea F. Bastianello S. Trojano M. Morino S. Morra V.B. Bozzao A. Calo A. et al. Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis 24-month clinical and MRI outcome. J Neurol. 1997; 244: 153-159 Crossref PubMed Scopus (272) Google Scholar To date, there is only limited information about the cardiotoxicity of low-dose mitoxantrone. Some studies suggest no adverse cardiac effects, but others have documented a decrease in the left ventricular ejection fraction in patients receiving mitoxantrone. 3 De Castro S. Cartoni D. Millefiorini E. Funaro S. Gasperini C. Morino S. Tallarico D. Beni S. Noninvasive assessment of mitoxantrone cardiotoxicity in relapsing remitting multiple sclerosis. J Clin Pharmacol. 1995; 35: 627-632 Crossref PubMed Scopus (53) Google Scholar , 4 Aviles A. Arevila N. Diaz Maqueo J.C. Gomez T. Garcia R. Nambo M.J. Late cardiac toxicity of doxorubicin, epirubicin, and mitoxantrone therapy for Hodgkin's disease in adults. Leuk Lymphoma. 1993; 11: 275-279 Crossref PubMed Scopus (57) Google Scholar A number of studies have shown that the diastolic parameters of left ventricular function were affected before systolic indexes. 5 Ganz W.I. Sridhar K.S. Ganz S.S. Gonzales R. Chakko S. Serafini A. Review of tests for monitoring doxorubicin-induced cardiomyopathy. Oncology. 1996; 53: 461-470 Crossref PubMed Scopus (163) Google Scholar , 6 Prestor V.V. Rakovec P. Kozelj M. Jereb B. Late cardiac damage of anthracycline therapy for acute lymphoblastic leukemia in childhood. Pediatr Hematol Oncol. 2000; 17: 527-540 Crossref PubMed Scopus (21) Google Scholar , 7 Suzuki J. Yanagisawa A. Shigeyama T. Tsubota J. Yasumura T. Shimoyama K. Ishikawa K. Early detection of anthracycline-induced cardiotoxicity by radionuclide angiography. Angiology. 1999; 50: 37-45 Crossref PubMed Scopus (34) Google Scholar , 8 Schmitt K. Tulzer G. Merl M. Aichhorn G. Grillenberger A. Wiesinger G. Hofstadler G. Early detection of doxorubicin and daunorubicin cardiotoxicity by echocardiography diastolic versus systolic parameters. Eur J Pediatr. 1995; 154: 201-204 Crossref PubMed Scopus (56) Google Scholar The present study evaluates whether conventional 2-dimensional and Doppler echocardiography can detect alterations in systolic or diastolic left ventricular function induced by low-dose mitoxantrone therapy, and more importantly, whether Doppler myocardial imaging (DMI) can contribute to the assessment of subtle changes of myocardial function.