Assessment of Left Ventricular Contractility in Patients Receiving Doxorubicin

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Abstract
The usual indices of left ventricular systolic performance have been incapable of accurately recognizing early myocardial impairment in many patients treated with doxorubicin. Recently, several new load-independent, highly sensitive indices of left ventricular contractility have been developed including the slope value of the end-systolic pressure (Pes)-dimension (Des) relation and the position of the left ventricular end-systolic wall stress (.sigma.es)-percent fractional shortening (%.DELTA.D) relation. These indices were used to study 46 patients receiving low dose or high dose doxorubicin. Results were compared with data from 30 healthy subjects. Resting %.DELTA.D failed to accurately recognize left ventricular dysfunction in 9 of 17 patients with low normal values. These patients had reduced afterload, as measured by .sigma.es, permitting normal extent of left ventricular fiber shortening despite impaired contractility as quantified by diminished Pes-Des slope value. There was 98% concordance between the relative position of the .sigma.es-%.DELTA.D relation and the slope value of the Pes-Des, relation. These indices offer an improved means of recognizing and quantitating impaired contractility in patients treated with doxorubicin. [Doxorubicin is an antineoplastic agent.].