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Serial Endomyocardial Biopsies and Systolic Time Intervals

Michael A. Friedman, MD; Marek J. Bozdech, MD; Margaret E. Billingham, MB; Alan K. Rider, MD

JAMA. 1978;240(15):1603-1606.

Abstract
Doxorubicin, whose dose-limiting toxicity is cardiomyopathy, was given to four cancer patients. Endomyocardial biopsy specimens and test results of cardiac function were obtained before, during, and after treatment. The biopsy specimens were examined by light and electron microscopy and were graded blindly. Evidence of specific doxorubicin injury was found in 3/4 patients with as little as 180 mg/sq m of the drug and became progressively more severe with higher doses. All test results of cardiac function, including systolic time intervals, remained normal. These data suggest that a specific, progressive subclinical injury to the heart occurs with doxorubicin therapy, which cannot be reliably detected by routine tests. This potential risk must be taken into account with the use of doxorubicin, especially when combined with synergistic agents.

(JAMA 240:1603-1606, 1978)

Author Affiliations
From the Cancer Research Institute and the Department of Medicine, University of California, San Francisco (Drs Friedman, Bozdech, and Rider), and the Department of Pathology, Stanford University, Stanford, Calif (Dr Billingham).

Footnotes
Read in part before the 34th annual meeting of the American Federation for Clinical Research, Washington, DC, May 2, 1977.

Reprint requests to 1282 Moffitt Hospital, University of California, Third and Parnassus Aves, San Francisco, CA 94143 (Dr Friedman).

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