Background
Despite its efficacy, FAC regimen may cause fatal cardiotoxicity. Carvedilol may also exert additional antioxidant effects. This study aimed to assess the effect of carvedilol in preventing decline of left ventricular function in breast cancer patients receiving FAC regimen chemotherapy.
Methods
The study was a quasi-experimental study. The study subjects were consisted of breast cancer patients currently receiving post-first cycle FAC chemotherapy regimen in period of March – May 2019. The study subjects were divided into 2 groups: control and intervention group. In intervention groups, the patients consumed up titrated carvedilol with initial dose of 2 × 6.25 mg daily, follow-up echocardiography was performed for the patients in order to assess GLS score of left ventricle.
Result
Eighty patients were enrolled to the study, with each group consisted of 40 patients. Patient baseline characteristics were not significantly different between both groups. Left ventricular function was assessed using speckle tracking echocardiography and assessing the change of GLS score. Decrease of GLS score was higher in the intervention group compared to the control group, although the decrease was not statistically significant (0.767 ± 0.355 vs. 0.897 ± 0.526; p = 0.838). Percentage wise, similar findings were reported, albeit no significant (3.34 ± 1.65 vs. 3.46 vs. 2.58; p = 0.968).
Conclusions
Carvedilol was not able to prevent the decline of subclinical left ventricular function after such chemotherapy cycle. However, it maybe more likely that the benefits appear in patients whose given larger cumulative dose of anthracycline and have multiple risk factors.
Background
Breast cancer survivors potentially develop cardiotoxicity after FAC regiment administration. Carvedilol may provide antioxidant, antiapoptotic, and myocyte-calcium regulation effects in chemotherapy. This study aimed to evaluate cardioprotective effects of Carvedilol towards preventing subclinical left ventricular dysfunction (SLVD) in breast cancer patients following FAC chemotherapy.
Methods
The study was a prospective open-label and Quasi-Experimental. We divided the patients receiving the FAC chemotherapy from September 2018 until May 2019 into intervention (IG) and control groups (CG). The IG received Carvedilol 6.25 mg b.i.d. up titrated every three weeks until the tolerated dose. We evaluated the left ventricular GLS changes and the incidence of SLVD (GLS reduction ≥15% and GLS >-18%) at 24 weeks after the FAC regimen initiation.
Result
Eighty-one women were enrolled in the study; 31 of them were the IG. There were no significant GLS changes during and after FAC completion in the IG, while the CG showed contradictive. At the end of follow-up, the delta GLS reduction was lower in the IG 0.7 (95% CI – 0.60,3.60) than the CG 3.00 (95% CI – 2.16,4.19), p = 0.035. The GLS percentage reduction showed similar results with 3.6% and 14.29% in the IG and CG respectively with p = 0.05. The incidence rate of SLVD (GLS reduction ≥15% and GLS >-18%) in IG was lower; 41.9% and 25.8%, while in the CG was 58% and 48%.
Conclusion
Carvedilol may have a cardioprotective effect by preventing the GLS reduction and reducing the incidence of SLVD in women with breast cancer after a complete cycle of FAC regimen.
AbstrakGagal jantung akut (AHF) adalah masalah medis yang umum dan berkembang dengan morbiditas dan mortalitas yang tinggi. Tingginya prevalensi AHF terkait dengan morbiditas dan kematian, diagnosis masih sukar dilakukan dan pengobatan optimal masih buruk. Identifikasi trigger akut untuk dekompensasi karakteristik peningkatan tekanan pengisian jantung (cardiac filling pressures) dan outputnya adalah penting untuk manajemen. Evaluasi pasien dengan gagal jantung (heart failure) adalah penting. Evalusi tersebut betujuan sebagai seleksi dan pengamatan/ monitor yang tepat untuk terapi juga mencegah dirawat kembali di rumah sakit. Diagnostik dan manajemen AHF merupakan tantangan heterogenitas dari populasi pasien, adanya pemahaman definisi universal, ketidak pahaman patofisiologi, dan kurangnya pedoman dasar berbasis Evidence-based medicine.
AbstractAcute heart failure (AHF) is a common and growing medical problem associated with major morbidity and mortality. Despite the high prevalence of this condition and its associated major morbidity and mortality, diagnosis can be difficult, and optimal treatment remains poorly defined. Identification of the acute triggers for the decompensation as well as characterization of cardiac filling pressures and output is central to management. Evaluation of patients with Heart Failure (HF) is critical for the appropriate selection and monitoring of therapy as well as for the prevention of recurrent hospitalizations.Diagnostic and management AHF is a challenge because of the heterogeneity of the patient population, the existence of a universal definition of understanding, not understanding the pathophysiology, and the lack of bases guideline Evidence-based medicine
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