24-hour mean pulse. Simple predictor of doxorubicin-induced cardiac damage

Nineteen adult patients with cancer received six to 10 monthly treatments of doxorubicin and cisplatin. Recumbent pulse was measured for 24 to 30 hours before each treatment. Treatment was stopped for disease progression or when a total doxorubicin dose of 550 mg/m2 was reached. Rising serial 24-hour pulse averages predicted congestive heart failure reliably. No patient had congestive heart failure during therapy, but three patients had congestive heart failure two to four months after receiving 540, 525, and 530 mg/m2 of doxorubicin. In these, two to six months before completion of therapy, the 24-hour rhythm-qualified mean (mesor) of pulse showed a positive slope by linear regression analysis (p less than 0.05) that was apparent at cumulative doxorubicin doses of 300, 420, and 240 mg/m2. All 19 patients received similar total doses of doxorubicin and were followed to death or 12 months after the last doxorubicin dose. In addition, a progressive rise in the 24-hour mean pulse coincided with histologically documented doxorubicin-induced lethal congestive heart failure in Wistar-Kyoto rats of both sexes.