Tissue-Doppler Assessment of Cardiac Left Ventricular Function during Short-Term Adjuvant Epirubicin Therapy for Breast Cancer
It has been hypothesized that the extent of acute anthracycline-induced cardiotoxicity reflects the risk for late development of heart failure. The aim of this study was to examine if short-term changes in cardiac function can be detected even after low-dose adjuvant epirubicin therapy for breast cancer when using Doppler tissue imaging of longitudinal left ventricular function.
Eighty consecutive women in good cardiopulmonary health scheduled to undergo adjuvant treatment for breast cancer were included. They were examined using echocardiography and Doppler tissue imaging before and after three treatment series of epirubicin (mean cumulative dose, 273.7 ± 46.6 mg/m(2); median time interval, 9 weeks; range, 47-113 days).
Apart from a marginal reduction in E/A ratio, none of the conventional Doppler echocardiographic or Doppler tissue imaging indices of systolic and diastolic function were affected during epirubicin treatment.
In contrast to several previous studies using tissue Doppler and conventional echocardiography, this study did not document relevant short-term effects of low-dose epirubicin treatment on heart function.
Available from: Maria del pilar estevez Diz
Available from: Umut Demirci
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ABSTRACT: Although systolic and diastolic left ventricular functions after cancer chemotherapy are well studied, there are a few investigations about the right ventricular functions. We aimed to investigate the early effects of chemotherapy on right heart, if any, in addition to the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart echocardiographic indices.
Thirty-seven consecutive patients with newly diagnosed breast cancer who were planned to receive either AC protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2))] or CAF protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2)) + 5-fluorouracil (600 mg/m(2))] for six cures were enrolled between February 2009 and June 2010. Echocardiography was performed before the onset of the chemotheurapeutic regimen (T1), on the day after the completion of the first cure (T2), and after the completion of two cures of the regimen (T3). Serum NT-proBNP levels were also measured at T1, T2, and T3. The mean right ventricular fractional area change (RVFAC) was 63.7 ± 3.63, 63.3 ± 3.67, and 61.2 ± 4.41% at T1, T2, and T3, respectively (pT1-T3 and pT2-T3 <0.05). Tricuspid annular plane systolic excursion (TAPSE) has decreased in time (1.82 ± 0.2, 1.78 ± 0.19, and 1.62 ± 0.24 cm; pT1-T2, pT1-T3, and pT2-T3 were 0.002, <0.001, and <0.001, respectively). Tricuspid annular mean E'/A' ratios were 1.42 ± 0.16, 1.36 ± 0.18, and 1.11 ± 0.32 (pT1-T2 = 0.013, pT1-T3 < 0.001, and pT2-T3 < 0.001). Mean tricuspid annular systolic velocities were 11.35 ± 1.85, 11.0 ± 1.82, and 10.45 ± 1.75 cm/s for T1, T2, and T3; and the differences between T1 and T2, T1 and T3, and T2 and T3 were all significant (P = 0.005, <0.001, and 0.001). Median serum NT-proBNP levels were 82 (60-247), 116 (60-426), and 170 (60-600) pg/mL at T1, T2, and T3. The amount of change in RVFAC and TAPSE between T1 and T3 were found to be correlated with the amount of change in NT-proBNP measurements between T1 and T3 (R: -0.7, P < 0.001; R: -0.62, P < 0.001).
There is a subclinical decrease in right ventricular systolic and diastolic echocardiographic indices, although mostly, in the normal range, in a relatively short time interval after onset of chemotherapy.
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ABSTRACT: Anthracyclines have profound consequences on the structure and function of the heart, which over time cause a cardiomyopathy that leads to congestive heart failure. Early detection of subclinical left ventricular (LV) dysfunction following a low dose of anthracyclines may be a preventive strategy. The aim of this study was to determine torsion analysis using two-dimensional speckle-tracking imaging (STI), useful for detecting early anthracycline-mediated cardiotoxicity.
Conventional and Doppler echocardiography images were obtained from 25 patients (mean age 58 ± 11 years) before chemotherapy and 1 and 3 months after treatment. The cumulative anthracycline doses were 98 ± 59 and 170 ± 87 g/m(2) at 1 and 3 months, respectively. After standard echocardiography, LV torsion and twisting velocity profiles from apical and basal short-axis images were analysed using STI. LV dimensions and ejection fraction did not change throughout follow-up. Although isovolumic relaxation time showed prolongation 3 months after chemotherapy, other Doppler indices did not show significant changes. However, significant deteriorations in torsion (P < 0.0001 by ANOVA), twisting rate (P < 0.0001 by ANOVA), and untwisting rate (P < 0.001 by ANOVA) were found 1 month after chemotherapy. A significant negative correlation was observed between cumulative anthracycline doses and torsion (r = -0.524, P < 0.0001).
LV torsion analysis could be a useful non-invasive approach for early detection of subclinical anthracycline cardiotoxicity.
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