Article Text

Usefulness of myocardial performance index in multiple sclerosis mitoxantrone-induced cardiotoxicity
  1. Paolo Pattoneri1,
  2. Giovanna Pelà2,
  3. Enrico Montanari3,
  4. Ilaria Pesci3,
  5. Paolo Moruzzi1,
  6. Alberto Montanari2
  1. 1Operative Unit of Cardiology, Hospital of Fidenza/San Secondo, Azienda USL di Parma, Parma, Italy
  2. 2Department of Clinical Sciences, University of Parma, Parma, Italy
  3. 3Operative Unit of Neurology, Hospital of Fidenza/San Secondo, Azienda USL di Parma, Parma, Italy
  1. Correspondence to Dr Paolo Pattoneri, Operative Unit of Cardiology, Hospital of Fidenza/San Secondo, Azienda USL di Parma, Parma, Italy; pattopaolo{at}


Aims The authors sought to investigate the ability of the Doppler-derived myocardial performance index (MPI) to predict cardiotoxicity in multiple sclerosis (MS) patients under mitoxantrone therapy.

Methods and results The aauthors prospectively evaluated 28 MS patients (mean age 41±9 years, 12 males and 16 females) treated with low-dose mitoxantrone (basal mean cumulative dose 30±14 mg/m2, end of follow-up mean dose 41±17 mg/m2). All patients underwent two-dimensional and Doppler-echocardiography at baseline and after a mean follow-up of 22±8 months. MPI was estimated using mitral inflow and left ventricular (LV) outflow pattern. Comparing data at baseline and at the end of follow-up, significant decrease in ejection fraction (EF) was observed (60±5 vs 56±4, p<0.03). The MPI was 0.52±0.1 at baseline and 0.60±0.1 at the end of follow-up (p<0.04). Such difference was mainly due to a isovolumic relaxation time prolongation (80±12 at baseline and 98±30 at the end of follow-up, p<0.05). The area under the receiver operating characteristic curve, analysed for an MPI cut-point value of 0.57, in identifying a significant reduction of LVEF ≤50% was of 0.94±0.065 with sensitivity and specificity of 97.5% and 90%, respectively.

Conclusion In conclusion, it can be speculated that a higher basal value of MPI could represent a subclinical LV cardiotoxicity, identifying a future decrease of EF and a progression to congestive heart failure in MS patients under mitoxantrone therapy.

  • Multiple sclerosis
  • myocardial performance index
  • echocardiography
  • mitoxantrone
  • cardiac function
  • systolic dysfunction
  • heart failure
  • cardiac resynchronisation therapy
  • hypertension
  • hypertensive heart disease

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The local medical ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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