Radionuclide ventriculography for evaluation and prevention of doxorubicin cardiotoxicity

Chemotherapy with doxorubicin often leads to congestive heart failure, particularly after cumulative doses of 550 mg/m2 have been reached. Certain risk factors, however, may predispose the patient to development of cardiomyopathy at lower doses. Radionuclide ventriculography with determinations of resting and exercise ejection fractions has emerged as the most reliable noninvasive screening procedure to detect subclinical cardiotoxicity. Before embarking on a course of doxorubicin therapy, patients should be stratified into low-risk and high-risk groups. Those in the high-risk group should undergo frequent monitoring by means of radionuclide ventriculography. For patients in the low-risk group, such monitoring could be postponed until they are ready to cross into the high-risk group by virtue of cumulative doxorubicin dose. Doxorubicin should be discontinued if the ejection fraction drops to less than or equal to 45% at rest or fails to increase with exercise.