Assessment of mitoxantrone-induced cardiotoxicity in patients with multiple sclerosis: a tissue Doppler echocardiographic analysis

Echocardiography. 2009 Apr;26(4):397-402. doi: 10.1111/j.1540-8175.2008.00812.x. Epub 2008 Nov 10.


Aim: Tissue Doppler echocardiography was investigated for its applicability in detecting subtle myocardial involvement in multiple sclerosis patients receiving a low dose of mitoxantrone.

Methods and results: Twenty Caucasian patients with multiple sclerosis (mean age 43.9+/-9.3 years, 12 males and 8 females) treated with mitoxantrone (mean cumulative dose 35.4+/-21.6 mg/m(2)), were compared to 20 healthy subjects (mean age 45.4+/-15.3 years, 11 males and 9 females) matched for age and gender. All subjects underwent conventional and Tissue Doppler echocardiography. Patients with heart failure, life-threatening arrhythmias, and other prominent manifestations of heart disease were excluded. No differences were observed in blood pressure, heart rate, and conventional systolic and diastolic echocardiographic parameters. At Tissue Doppler echocardiography, patients with multiple sclerosis showed differences of the systolic mechanic expressed by a significant lower S-wave peak velocity at the lateral site of mitral annulus (11.4+/-2.5 cm/sec vs. 15.0+/-4.1 cm/sec, P < 0.02). Such S-wave peak velocity significantly correlated with a cumulative dose of mitoxantrone (r =-0.37, P < 0.05).

Conclusion: Tissue Doppler echocardiography suggests an early involvement of the systolic myocardial function at the low dose of mitoxantrone. Therefore, Tissue Doppler echocardiography may be used as a noninvasive method for monitoring subclinical cardiotoxicity in multiple sclerosis patients receiving mitoxantrone.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Echocardiography, Doppler / methods*
  • Elasticity Imaging Techniques / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mitoxantrone / adverse effects*
  • Mitoxantrone / therapeutic use*
  • Multiple Sclerosis / complications*
  • Multiple Sclerosis / diagnostic imaging
  • Multiple Sclerosis / drug therapy*
  • Ventricular Dysfunction, Left / chemically induced*
  • Ventricular Dysfunction, Left / diagnostic imaging*


  • Mitoxantrone