Guideline for Serial Monitoring of LVEF by ERNA for Patients Undergoing Chemotherapy with Anthracyclines (9,10)

Normal LVEF at baseline (≥50%)
  Baseline ERNA before initiating chemotherapy
  Next ERNA at 250–300 mg/m2 dose
  Next ERNA at 450 mg/m2 (400 mg/m2 if high risk*)
  Next ERNA before each dose > 450 mg/m2
 Discontinue therapy if LVEF decreases ≥10% (EF units) from baseline and reaches <50%
Abnormal LVEF at baseline (>30% to <50%)
  Baseline ERNA before initiating chemotherapy
  Serial ERNA before each subsequent dose
 Discontinue therapy if LVEF decreases ≥ 10% (EF units) from baseline or reaches ≤ 30%
LVEF ≤ 30% at baseline
 Do not initiate therapy
  • * High-risk features include use of cyclophosphamide, heart disease, mediastinal radiation, and abnormal ECG.