Subclinical Myocardial Dysfunction in Multiple Sclerosis Patients Remotely Treated With Mitoxantrone: Evidence of Persistent Diastolic Dysfunction |
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| Authors: | Emer Joyce Eoin Mulroy Jaqueline Scott Jane Melling Carole Goggin Catherine Mcgorrian Killian O'Rourke Timothy Lynch Niall Mahon |
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| Affiliation: | 1. Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland;2. Dublin Neurological Institute, Mater Misericordiae University Hospital, Dublin, Ireland;1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina;2. Department of Medicine, Duke University School of Medicine, Durham, North Carolina;3. Department of Medicine, University of Alberta, Edmonton, Alberta;4. Department of Medicine, University of California, and San Francisco VA Hospital, San Francisco, California;5. Cleveland Clinic, Cleveland, Ohio;1. Duke University Medical Center, Durham, North Carolina;2. Hospices Civils de Lyon & UMR5558, CNRS, Université Lyon 1, Université de Lyon, Lyon, France;3. National Heart, Lung, and Blood Institute, Bethesda, Maryland;4. Lariboisière Hospital, Paris, France;5. University Medical Center Groningen, Groningen, The Netherlands;6. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;7. Montefiore-Einstein Medical Center, The Bronx, New York, New York;8. University of Manchester, Manchester, United Kingdom;9. BG Medicine, Waltham, Massachusetts;10. University of Michigan, Ann Arbor, Michigan;11. Nancy University, Nancy, France;12. University of Colorado Health Sciences Center, Denver, Colorado;13. ARCA Biopharma, Denver, Colorado;1. Department of Veterans Affairs, Pharmacy Benefits Management Services, Hines, Illinois;2. Western University of Health Sciences, College of Pharmacy, Pomona, California;3. Palo Alto Department of Veterans Affairs Health Care System, Palo Alto, California;4. Pittsburgh Department of Veterans Affairs Healthcare System, Pittsburgh, Pennsylvania;5. Johns Hopkins Home Care Group, Baltimore, Maryland;6. Boise Department of Veterans Affairs Medical Center, Boise, Idaho;7. Long Beach Department of Veterans Affairs Healthcare System, Long Beach, California;1. Division of Physical Therapy, Ceilandia College, University of Brasilia, Brasilia, Brazil;2. Ergometry and Sports Medicine Department, Heart Institute of Distrito Federal, Brasília, Brazil;3. Department of Physical Therapy, University of Miami, Miami, Florida;4. Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois;1. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;2. Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Cardiology Division, Emory University Hospital, Atlanta, Georgia |
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| Abstract: | BackgroundMitoxantrone is an effective disease-modifying therapy in multiple sclerosis (MS), but its use is limited by cardiotoxicity. We evaluated global myocardial function, including myocardial performance index (MPI), on echocardiography in MS patients after remote mitoxantrone treatment.Methods and ResultsConsecutive patients (n = 50) treated with standard-protocol mitoxantrone from 2002 to 2010 in our center were identified. After exclusion of those who had died (n = 4; all noncardiac) or had developed interim cardiovascular disease or risk factors (n = 3), 33 (mean age 49 ± 11 years, 45% male, median follow-up 77 months, mean cumulative dose 72 mg/m2) of the remaining patients (77%) underwent 2-dimensional echocardiography. A comparison group of 17 age- and sex-matched control subjects were included. No significant differences occurred in standard echocardiographic parameters between groups. However, mean MPI (defined as isovolumic contraction time plus isovolumic relaxation time (IVRT) divided by ejection time) was significantly higher in patients (0.51 ± 0.12 vs 0.39 ± 0.06; P = .02) owing to a significantly prolonged IVRT (81 ± 25 vs 60 ± 9 ms; P = .04). Overall MPI was >0.5 in 18 patients compared with none of the control subjects (54.5% vs 0%; P < .001).ConclusionsA subclinical form of global myocardial dysfunction reflecting primarily diastolic dysfunction may be present in MS patients after remote standard-dose mitoxantrone treatment. |
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| Keywords: | Echocardiography Tei index diastolic function cardiotoxicity |
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