Invasive and noninvasive methods of assessing adriamycin cardiotoxic effects in man: superiority of histopathologic assessment using endomyocardial biopsy.

Endomyocardial biopsies and cardiac catheterizations were performed in 55 patients treated with adriamycin (ADM). Eleven patients underwent serial invasive studies. In addition, most of these patients had systolic time interval determinations, echocardiograms, and electrocardiograms at the time of catheterization. The relationship of these various tests to cumulative dose of ADM and to the incidence of cardiac dysfunction was analyzed. Only pathologic assessment of ADM-induced myocardial damage showed a progressive stepwise increase in severity at successively higher doses of ADM. In addition, the incidence of myocardial dysfunction correlated well only with pathologic findings on biopsy. We conclude that standard noninvasive methods of assessing ADM cardiotoxicity are inadequate and that histopathologic assessment by means of endomyocardial biopsy is a valuable, reliable, and accurate technique.