Prior to initiating doxorubicin, which cardiac assessment is prioritized?

• A. Left ventricular function assessment via MUGA or echocardiogram
• B. Ejection fraction testing with LV imaging prior to therapy
• C. Pulmonary function tests
• D. Serum liver enzymes

Answer: (A)

Doxorubicin carries a known risk of dose-related heart damage, so the most important step before starting therapy is to establish how well the left ventricle is pumping. This is done with an imaging-based assessment of left ventricular function, typically measuring the ejection fraction. Using a MUGA scan or an echocardiogram provides a quantitative baseline that can be tracked over the course of treatment. If the ejection fraction drops or if there are heart-related symptoms, clinicians can adjust the plan—such as modifying the dose or considering protective strategies.

MUGA offers precise, reproducible measurements of ejection fraction, while echocardiography is widely available, noninvasive, and doesn’t involve radiation. Either test serves the same purpose of establishing LV function at baseline.

Pulmonary function tests don’t directly assess the risk of doxorubicin-induced cardiotoxicity, and serum liver enzymes relate more to hepatic function than to cardiac risk, so they aren’t the priority for this purpose.