Original article
Ultrasonic analysis of anthracycline-induced myocardial damage using cyclic variation of integrated backscatter

https://doi.org/10.1067/S0894-7317(03)00425-5Get rights and content

Abstract

To test the feasibility of integrated backscatter (IB) for detecting anthracycline cardiotoxicity, we performed conventional echocardiography and IB analysis. For interindividual comparison, 32 patients with non-Hodgkin’s lymphoma and 14 control subjects were selected. Of the patients, 10 had been treated with doxorubicin doses of ≤200 mg/m2 (low dose), 15 with ≤400 mg/m2 (moderate dose), and 7 with >400 mg/m2 (high dose). In intraindividual comparison, 8 patients were examined before doxorubicin therapy and at a dose of 100 mg/m2 and 8 were examined before and at a 300-mg/m2 dose. Cyclic variation of IB (CV-IB) was obtained at the left ventricular posterior wall, using a modified, commercially available system in M-mode format. In interindividual comparison, CV-IB in high- and moderate-dose groups was smaller. In intraindividual comparison, CV-IB decreased after treatment with 300 mg/m2 of doxorubicin. CV-IB was affected in some patients treated with a moderate dose of doxorubicin. IB analysis may be helpful for detecting early anthracycline cardiotoxicity.

Section snippets

Study population

Between April 1998 and September 2000, 126 patients with various hematologic malignancies were referred to our cardiology department for echocardiographic evaluation. In 12 patients, IB analyses were not completed because their images were not suitable. Complete IB data were obtained from 114 patients (90%). A total of 3 patients who had a history of heart failure were excluded. Of these patients, 32 patients with non-Hodgkin’s lymphoma (17 men, 15 women; age 52 ± 13 years) who had been treated

Interindividual comparison

As shown in Table 1 and Figure 1, patients with non-Hodgkin’s lymphoma in the low-dose group had been treated with 105 ± 60 mg/m2 of doxorubicin; in moderate-dose group with 297 ± 48 mg/m2; and in high-dose group with 529 ± 70 mg/m2. There was a progressive decrease in LV ejection fraction from 69% to 61% among 4 groups, which was still in the normal range and not statistically significant. This change seemed to be a result of small but gradual increase in LV systolic dimension. There were no

Discussion

In this study, CV-IB was blunted in patients with non-Hodgkin’s lymphoma who were treated with moderate doses of anthracyclines, although their conventional systolic and diastolic parameters were apparently not affected. This fact suggests that subclinical myocardial damage is already induced by moderate doses of anthracyclines and that noninvasive IB analysis can detect the early cardiotoxicity.

Acknowledgements

We would like to thank Drs Hirokazu Okumura and Shinji Nakao, the Department of Cellular Transplantation Biology, Graduate School of Medical Science, Kanazawa University, for the collection of the study patients.

This article is dedicated to the memory of Prof Kenichi Kobayashi, who died on November 3, 2002.

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    Supported by a research grant from the Ministry of Education, Science, and Culture of Japan (No. 10770305).

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