[Drug-induced myocardial disease--adriamycin cardiotoxicity]

Myocardial damage may be induced by several categories of drugs. Adriamycin is one of the most effective chemotherapeutic agents. Unfortunately, it develops a distinctive and life-threatening congestive heart failure by well-characterized, dose-dependent cardiac toxicity. Left ventricular ejection fraction determined using echocardiography or radionuclide angiography does not decrease sensitively and linearly with the adriamycin dose level. Cardiac function is preserved until a critical degree of myocardial damage is reached, after which myocardial performance deteriorates rapidly. Biochemical monitoring may be a novel sensitive and specific method for detecting subclinical myocardial damage. Abnormal cardiac adrenergic neuron activity evaluated with radiolabeled MIBG, impaired myocardial glucose utilization measured with F-18-FDG and plasma brain natriuretic peptide levels increased due to cardiac dysfunction may be particularly sensitive markers of adriamycin cardiotoxicity. It is hoped that prospective clinical study reveals the values of these biochemical markers.