Circadian mesor of recumbent pulse--cost-effective predictor of doxorubicin-induced congestive heart failure.

Nineteen adult cancer patients each received 6-10 monthly treatments of doxorubicin and cisplatin. For 24-30 hr before each treatment, recumbent pulse was measured. Treatment was stopped for disease progression or when a total doxorubicin dose of 550 mg/m2 was reached. No patient developed congestive heart failure (CHF) during therapy. Two to four months after stopping treatment, three patients developed CHF. In these cases, 2-6 months before complication of therapy, prior to notable decrement in any other index of cardiac function, the 24-hr rhythm-qualified mean (mesor) of pulse showed a positive slope by linear regression analysis (P less than 0.05). This mesor rise was apparent at cumulative doxorubicin doses of 300, 420 and 240 mg/m2. patients subsequently received additional doxorubicin to total doses of 540, 525 and 530 mg/m2. Patients who did or did not experience a rise in pulse received similar total doses of doxorubicin. Serial pulse mesors predicted CHF reliably and were substantially less expensive than radionuclide ejection fraction determination ($200 per test). A progressive rise in the circadian pulse-mesor was clearly a harbinger of histologically documented doxorubicin-induced lethal CHF in Wistar-Kyoto rats of both sexes.