Comparison of stress echocardiography and radionuclide ventriculography in the diagnosis of cardiomyopathy in patients receiving chemotherapy for malignant diseases

BACKGROUND AND OBJECTIVE: Early evidence of drug-induced cardiomyopathy (CMP) is of great importance in haematological treatment, especially with anthracyclines. Stress echocardiography (SEC) has proved of value in determining left ventricular function at rest and under stress in patients with heart disease. The study was undertaken to assess the value of SEC in comparison with radionuclide ventriculography (RNV). PATIENTS AND METHODS: 63 unselected patients with malignant tumour (20 women, 43 men; mean age 49 +/- 15 years) underwent SEC and RNV. No chemotherapy had yet been started in 17 of them, 43 had received anthracyclines as main component of the chemotherapy (mean anthracycline dose 339 +/- 251 mg/m2). Left ventricular ejection fraction (LVEF) was measured by both SEC and RNV at rest and during standardized stress (recumbent ergometry). Both methods were applied and results measured independently by two examiners. RESULTS: The time interval between the two tests averaged 1 = 2 days. EC could be performed at rest in 62 of 63 and under stress in 59 of 63 patients (RNV: 63 of 63 and 54 of 63, respectively). Resting LVEF was 61 +/- 8% by SEC and 64 +/- 9% by RNV (P < 0.05). LVEF during stress, measured by SEC, was 71 +/- 11% and 73 +/- 10% by RNV (not significant). Mean LVEF increase between rest and stress was 9 +/- 10% by SEC and 9 +/- 8% by RNV (not significant). CONCLUSION: SEC is a satisfactory alternative to RNV in the assessment of ventricular function in patients receiving chemotherapy. It is less involved and more cost-effective than RNV, avoids radiation exposure and provides additional information on heart size and segmental contraction abnormalities.