A 62-year-old woman with lymphoma completed a chemotherapy course two years ago and now presents with progressive dyspnea. Echocardiography shows a dilated left ventricle with LVEF 30%. Which feature best supports anthracycline-related cardiomyopathy rather than an ischemic cause?
- A Diffuse biventricular hypokinesia with global reduction in strain, related to the cumulative dose received ✓
- B Regional wall motion abnormality corresponding to a single coronary territory
- C Normal ventricular size with isolated diastolic dysfunction
- D Recovery of ejection fraction to baseline within days of stopping the drug
Correct answer: A. Diffuse biventricular hypokinesia with global reduction in strain, related to the cumulative dose received
Explanation
Anthracyclines such as doxorubicin cause type I (irreversible) cardiomyopathy through free radical generation and topoisomerase II beta mediated myocyte death. Injury is dose dependent with risk rising sharply above a cumulative threshold of roughly 450 to 550 mg/m2, and it produces global, not regional, systolic dysfunction. Regional wall motion abnormalities point to epicardial coronary disease, and the toxicity does not reverse within days of drug withdrawal.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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