Überwachung der Myokardfunktion während der Therapie mit kardiotoxischen Zytostatika

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Abstract
A concept of non-invasive assessment of cardiomyopathy (CM) in cytostatic treatment, especially with [the antineoplastic drug] Docorubicin [adriamycin] (A), was studied. In a follow-up study during therapy with A, 150 patients were examined by the following: ECG (QRS wave amplitude); systolic time intervals (STI); preejection period vs. left ventricular ejection time (PEP/LVET), normal value .gtoreq. 0.45; PEP corrected to 0-frequency (PEPc), normal value .gtoreq. 147 ms; echocardiography (UCG); shortening fractions (SF), normal value > 30%; and in 6 cases by microcatheter with exercise test. ECG apparently does not predict CM. Eleven patients (7%) had abnormal SF in UCG were examined by microcatheter, 5 having symptoms of CM. Six patients without clinical signs of CM were examined by microcatheter, 5 having abnormal pressure or HbO2 in the pulmonary artery at exercise. Nearly all patients with abnormal SF had objective signs of latent or overt CM. PEP/LVET was abnormal in all patients with CM, but false positive in 44% of all investigations, mostly by shortening of LVET. PEPc, also abnormal in all patients with CM, was false postive in only 12%. UCG apparently is the most specific noninvasive method for assessment of CM in cytostatic treatment. STI are less specific but highly sensitive to CM and, therefore, useful screening method. PEPc allows better selection than PEP/LVET because of its higher specifity. STI, contrary to UCG, can easily be obtained outside cardiologic centers, i.e., in the oncologic department itself, so that UCG is needed only in .apprx. 15-20% of patients. Cardiotoxic treatment shoiuld be stopped when all values are abnormal, even when patients are asymptomatic. Since this policy was adopted, none of the last 100 patients have died from CM.

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