[Echocardiographic detection of adriamycin cardiotoxicity. Study of the relationship between the shortening fraction-constraint and the systolic shortening fraction-diameter of the left ventricle].

Cardiotoxicity is the main obstacle to the use of high-dosage adriamycin in chemotherapy. It is difficult to decide whether or not treatment should be continued when the cardiac function -- irrespective of the method by which it is evaluated -- is at the lower limit of normality. Some authors consider that chemotherapy can be pursued as long as the shortening fraction of the echocardiographic diameter remains within normal limits in relation to the end-systolic constraint. We have established the limits of normality of this relationship before chemotherapy in 53 patients with normal cardiovascular system. We conclude that the end-systolic constraint essentially depends on the end-systolic diameter, so that the results provided by the study of the shortening fraction end-systolic constraint relationship are qualitatively the same as those of the shortening fraction-end-systolic diameter relationship, which is much easier to obtain. It seems to us that the criteria of cardiotoxicity after administration of adriamycin 300 mg/m2 are: (1) shortening fraction lower than 25 p. 100; (2) ventricular dilatation (end-systolic diameter greater than 40 mm) without associated valve disease; (3) reduction of the shortening fraction (whatever its value) in relation to the end-systolic diameter by more than 2 standard deviations on the regression slope of the correlation; (4) more than 25 p. 100 reduction of the shortening fraction after administration of adriamycin 300 mg/m2, betraying a high sensitivity to the cardiotoxic effects of the drug. Such individual sensitivity, studied in 25 patients, seemed to vary widely from one subject to another and to be independent of the initial status.(ABSTRACT TRUNCATED AT 250 WORDS)