Doxorubicin cardiomyopathy – case report and review of histopathologic findings (RCD code: III‐1B.5a)

Hamza Tariq, Urooj Zahra

Full Text:



The anthracycline anticancer drug Doxorubicin (Adriamycin) is an effective and frequently used chemotherapeutic agent for various malignancies. The use of doxorubicin is limited by its major adverse effect, cardiotoxicity. Doxorubicin cardiomyopathy, once developed, carries a poor prognosis with a mortality rate of over 50%. Although invasive, histopathologic analysis of myocardial tissue remains the most sensitive and specific method of diagnosing doxorubicin cardiomyopathy. Histopathologic analysis reveals not only the characteristic diagnostic features of the disease but also aids in grading the severity of doxorubicin cardiomyopathy, which guides further therapy. We report the autopsy findings of a 31-year-old man with a history of T-cell Acute Lymphoblastic Leukemia (ALL) who died of severe doxorubicin induced dilated cardiomyopathy after he was given multiple rounds of hyperfractionated Cyclophosphamide, Vincristine, Adriamycin (doxorubicin) and Dexamethasone (hyper-CVAD) over a period of six years. JRCD 2017; 3 (5): 176–179


Doxorubicin; Adriamycin; cardiomyopathy; leukemia; rare disease


Takemura G and Fujiwara H. Doxorubicin-Induced Cardiomyopathy. From the Cardiotoxic Mechanisms to Management. Progress in Cardiovascular Diseases 2007; 49: 330–352.

Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin. A retrospective analysis of three trials. Cancer 2003; 97: 2869–2879.

Chatterjee K, Zhang J, Honbo N, Karliner J. Doxorubicin Cardiomyopathy. Cardiology 2010;115:155–162

Lefrak EA, Pitha J, Rosenheim S, et al. A clinicopathologic analysis of adriamycin cardiotoxicity. Cancer 1973; 32: 302–314.

Von Hoff DD, Layard MW, Basa P, et al. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med 1979; 91: 710–717.

Gewirtz DA. A critical evaluation of the mechanisms of action proposed for the antitumor effects of the anthracycline antibiotics Adriamycin and daunorubicin. Biochem Pharmacol 1999; 57: 727–741.

Singal PK, Deally CM, Weinberg LE. Subcellular effects of Adriamycin in the heart: a concise review. J Mol Cell Cardiol 1987; 19: 817–828.

Singal PK, Segstro RJ, Singh RP, Kutryk MJ. Changes in lysosomal morphology and enzyme activities during the development of Adriamycin-induced cardiomyopathy. Can J Cardiol 1985; 1: 139–147.

Monti E, Prosperi E, Supino R, Bottiroli G. Free radical-dependent DNA lesions are involved in the delayed cardiotoxicity induced by Adriamycin in the rat. Anticancer Res 1995; 15: 193–197.

Billingham ME, Mason JW, Bristow MR, et al. Anthracycline cardiomyopathy monitored by morphologic changes. Cancer Treat Rep 1978; 62: 865–872.

Schwartz RG, McKenzie WB, Alexander J, et al. Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy. Seven-year experience using serial radionuclide angiocardiography. Am J Med 1987; 82: 1109–1118.

From AM, Maleszewski JJ, Rihal CS. Current Status of Endomyocardial Biopsy. Mayo Clinic Proceedings. 2011;86(11):1095–1102. doi:10.4065/mcp.2011.0296.

Menna P, Salvatorelli E. Primary Prevention Strategies for Anthracycline Cardiotoxicity: A Brief Overview. Chemotherapy 2017; 62:159–168.

Minotti G, Menna P, Salvatorelli E, et al. Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev 2004; 56:185–229.

Cardinale D, Colombo A, Bacchiani G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015; 131:1981–1988.

Zamorano J, Aboyans V, Achenbach S, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. European Heart Journal 2016; 37:2768–2801

Arico M, Pedroni E, Nespoli L, Vigano M, Porta F, Burgio GR. Long-term survival after heart transplantation for doxorubicin-induced cardiomyopathy. Arch Dis Child 1991; 66:985–986.



  • There are currently no refbacks.
Journal of Rare Cardiovascular Diseases (JRCD)
John Paul II Hospital in Kraków, 80 Prądnicka Str., 31-202 Kraków, Poland
Phone: +48 (12) 614 33 99, +48 (12) 614 34 88 Fax: +48 (12) 614 34 88
Published by SoftQ sp. z o.o.
ul. Oleandry 2, 30-063 Kraków, Poland
Phone: +48 (12) 444 1650 Fax: +48 (12) 444 1659