AGE AND LEFT-VENTRICULAR EJECTION FRACTION IDENTIFY PATIENTS WITH ADVANCED BREAST-CANCER AT HIGH-RISK FOR DEVELOPMENT OF EPIRUBICIN-INDUCEDHEART-FAILURE

Background. To evaluate the possibility of predicting development of h eart failure, we monitored left ventricular ejection fraction (LVEF) i ns addition to demographic data in patients with advanced breast cance r treated with epirubicin. Methods and Results, LVEF determination Ibv radionuclide angiocardiography was performed serially before, during, and after treatment with 130 mg epirubicin/m(2) every 3 weeks until d isease progression or a cumulative dose of 1000 mg/m(2) was reached (o r heart failure! occurred), Among 67 patients, heart failure developed in eight (12%), rage was 5 to 8 years greater and baseline LVEF was 7 % less (95% confidence interval 3% to 13%) in patients who had heart f ailure than in the remaining patients, LVEF was slightly reduced in al l patients during treatment, Three combined criteria, age greater than or equal to 50 years, baseline LVEF less than or equal to 0.60, and d ecrease in LVEF to 0.50, had a positive predictive value of 70% (95% c onfidence interval 35% to 93%) and a negative predictive value of 98% (95% confidence interval 90% to 100%) with respect to development of h eart failure, Conventional LVEF criteria were of less diagnostic value , Conclusions. Our results indicate that age and baseline LVEF: determ ination mark a group of patients at high risk for development of epiru bicin-induced heart failure, Monitoring of serial LVEF is indicated du ring treatment of these patients.