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Guidelines for monitoring cardiac function in patients receiving doxorubicin

Guidelines for monitoring cardiac function in patients receiving doxorubicin
Perform baseline radionuclide angiocardiography at rest for calculation of left ventricular ejection fraction (LVEF) prior to administration of 100 mg/m2 doxorubicin.
Subsequent studies are performed at least three weeks after the indicated total cumulative doses have been given, before consideration of the next dose.
Patients with normal baseline LVEF (≥50 percent)
Perform a second study after 250 to 300 mg/m2. Repeat study after 400 mg/m2 in patients with known heart disease, radiation exposure, abnormal electrocardiographic results, or cyclophosphamide therapy; or after 450 mg/m2 in the absence of any these risk factors.
Perform sequential studies thereafter prior to each dose. 
Discontinue doxorubicin therapy once functional criteria for cardiotoxicity develop, eg, absolute decrease in LVEF ≥10 percent (EF Units) associated with a decline to a level of ≤50 percent (EF Units).
Patients with abnormal baseline LVEF (≤50 percent)
Doxorubicin therapy should not be initiated with baseline LVEF ≤30 percent.
In patients with LVEF >30 percent and <50 percent, sequential studies should be obtained prior to each dose.
Discontinue doxorubicin with cardiotoxicity: absolute decrease in LVEF ≥10 percent (EF units) and/or final LVEF ≤30 percent.
LVEF: left ventricular ejection fraction.
Adapted from: Schwartz RG, McKenzie WB, Alexander J, et al. Am J Med 1987; 82:1109.
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