Dobutamine Stress Echocardiography: Beyond Traditional Uses

Anthracyclines are among the most widely used and effective antineoplastic agents. A growing number of patients treated with anthracyclines may have the potential for substantial morbidity and mortality owing to anthracycline cardiotoxicity. Patients younger than 75 years and without heart failure or pulmonary disease are more likely to receive chemotherapy. The main manifestations of acute cardiotoxicity are cardiac rhythm disturbances and the pericarditis/myocarditis syndrome, while early (several days to months following therapy) and late (years to decades after treatment) cardiotoxicity is mainly characterized by deterioration of myocardial function. Subclinical cardiomyopathy is quite more prevalent than symptomatic heart failure. Various predisposing factors have been proposed, such as total dose of anthracyclines > 550mg/m2, high rate of administration, previous chest irradiation, young or advanced age, female sex, and coexistent heart disease and/or arterial hypertension. The early detection of cardiotoxicity may lead to the modification of chemotherapeutic regimen, and to the timely administration of medications for the treatment of cardiomyopathy, such as beta-blockers and ACE inhibitors. Echocardiography during low dose dobutamine infusion (10 mg/kg/min) has the potential to reveal abnormalities of myocardial contractile reserve, while Doppler echocardiography of the mitral valve inflow during diastole has been used for the assessment of left ventricular (LV) diastolic function. This study examines whether the combination of repetitive dobutamine stress echocardiography (DSE) with evaluation of Doppler mitral inflow pattern can be used to predict the development of anthracycline cardiomyopathy.