Should We Modify Follow Up Recommendations for Cardiac Follow-Up of Patients during Oncologic Treatment Using other Parameters in Replacement of LVEF?

Abstract

Since the initial description of cardiac abnormalities induced by the administration of chemotherapeutic agents there has been a documented evolution of methods to find the evidence of such cardiac dysfunction in the heart. The obvious interest has been, not only to treat, but to perhaps even prevent the cardiac changes altogether. This is well illustrated thru recent history; in particular with the case of adriamycin toxicity (1-2). One of the first methods suggested early on this evolution (1974) was the combination of ECG and chest X Ray films in conjunction to phonocardiography and carotid pulse tracing with serial photography used to describe the ratio of pre-ejection period to left ventricular ejection time (3). Shortly after, in 1976, a new non-invasive method was described using sphygmo-recording of the pulse wave delay (4). Ultrasound imaging quickly followed in a report from the pediatric population (5). Once cardiac imaging was established in the late 70’s and early 80’s; a number of publications supported the different modalities available (5-8). It is then; fair to say that early in the decade of the 1980’s left ventricular ejection fraction (LVEF) was recognized as the traditional method for initial and follow-up evaluation of ventricular function during the administration of cardiotoxic chemotherapeutic agents. At the time the most developed modality, and what was considered the gold standard for the evaluation of LVEF non-invasively was radionuclide angiography. A look into the literature of that time will clearly reveal a chronological and timing advantage of the nuclear imaging modalities. LVEF by radionuclide proved to be sensitive, specific, reproducible and in at least one early report a predictor of early toxicity when used with stress (9). LVEF, as a single measure, was clearly the real strength of this imaging technique. It took years for echocardiography, as an imaging method, to parallel the accuracy values that nuclear tests had so well displayed. After all, it was in 1979 when the LVEF by two dimensional echocardiography methods started to be established and compare favorably with Agonist Jose Banchs, MD, FAcc, FASe