Adriamycin (NSC 123127) cardiomyopathy. An overview with determination of risk factors

The clinical and pathologic features of adriamycin cardiomyopathy are reviewed. Two types of cardiac effects are attributed to adriamycin: various nonspecific electrocardiogram abnormalities, and dose related congestive heart failure. Attempts are being made to detect adriamycin induced cardiotoxicity before clinically significant damage has occurred. The systolic time interval, echocardiograms, and electrocardiogram limb lead QRS voltages are discussed. In addition, several factors which increase the risk of cardiac toxicity developing have been identified. Cardiomyopathy developed at lower cumulative doses of adriamycin in patients who had had prior radiation therapy in which any portion of the heart was included in the treatment field or in patients who had received cyclophosphamide concurrently with adriamycin. We are presently limiting these patients to a cumulative dose of adriamycin of 450 mg/m².