Early mitoxantrone-induced cardiotoxicity in secondary progressive multiple sclerosis

The duration of infusion over 60 min makes peak plasma levels unlikely to cause transient cardiac dysfunction. 13 Our data on early diastolic changes are in line with oncological studies on anthracycline-induced cardiotoxicity, which show that diastolic dysfunction may occur independently of left ventricular systolic function or precede disturbances there. 14- 16 A recent study which reported no marked early decrease of LVEF during treatment with mitoxantrone in multiple sclerosis did not measure functional diastolic parameters. 17 Histopathological data on anthracycline cardiotoxicity suggest a possible change in diastolic performance as a result of increased myocardial stiffness. 18 The clinical effect of early cardiotoxicity is unclear, and to date it is not known whether early subclinical changes are a risk factor for symptomatic cardiac dysfunction later in the course of mitoxantrone treatment or after its completion. The best method for assessment of cardiac function under mitoxantrone treatment in patients with multiple sclerosis has not been evaluated, and there are no longitudinal studies comparing different techniques (ie, echocardiography, radionuclide ventriculography and magnetic resonance imaging). [...]prospective studies for monitoring cardiac function in patients with multiple sclerosis under mitoxantrone are urgently needed.