Dobutamine Stress Echocardiography Identifies Anthracycline Cardiotoxicity

Background: Anthracyclines are effective anti-cancer agents, but their therapeutic value is limited by their myocardial toxicity. We assessed the physiological responses of stress echocardiography at low doses of dobutamine (DSE) in patients treated with anthracycline. Methods and Results: In a prospective study, 28 patients were studied before and 1 month after the end of chemotherapy. All patients had normal ejection fraction (EF) at rest before therapy and the mean dose of anthracycline was 212±15mg/m². Echocardiographic Doppler studies were performed before and during dobutamine infusion (5 and 10μg/kg per min). Rest echocardiography demonstrated a significant decrease of EF between the two examinations in ejection fraction (67±3% vs. 61±3%, P<0·001). The increase of the EF during dobutamine infusion was higher after chemotherapy compared to the initial examination (19±3% vs. 29±3%: P<0·05). No difference in EF was observed at 10μg/kg per min between before and after chemotherapy. In contrast, at rest no difference in diastolic parameters was observed between the two examinations. Moreover, a significant decrease of the peak E and the ratio E/A was observed during dobutamine infusion after chemotherapy (93±4cm/s vs. 79±5cm/s and 1·3±0·1 vs. 1·0±0·1, respectively;P<0·05). Conclusion: Stress echocardiography may prove to be a sensitive technique and useful non-invasive approach for evaluating subclinical anthracycline cardiotoxicity.