Arterial Stiffness Use for Early Monitoring of Cardiovascular Adverse Events due to Anthracycline Chemotherapy in Breast Cancer Patients. A Pilot Study

Abstract

BackgroundChemotherapy with doxorubicin and cyclophosphamide, although efficient for treating breast cancer, is associated with cardiovascular complications. Recent studies seek to identify methods that can early detect cardiological and vascular changes as a strategy to decrease the incidence of cardiovascular comorbidities.ObjectiveTo evaluate the role of arterial stiffness measurement in the monitoring of doxorubicin and cyclophosphamide-induced cardiotoxicity in breast cancer patients.MethodsProspective longitudinal study in 24 breast cancer patients undergoing treatment with doxorubicin and cyclophosphamide. Patients underwent an indirect evaluation of arterial stiffness through non-invasive measurement of hemodynamic parameters such as pulse wave velocity with the Mobil-O-Graph® 24H PWA device at three different times of the chemotherapy treatment (pre-chemotherapy, after the first and the fourth cycle). The left ventricular ejection fraction was also evaluated by Doppler echocardiography (pre-chemotherapy and after the fourth chemotherapy cycle). Data were considered significant when p ≤ 0.05.ResultsPatients had a mean age of 52.33 ± 8.85 years and body mass index of 31 ± 5.87 kg/m2. There was no significant difference between the hemodynamic parameters evaluated by the oscillometric method or in the left ventricular ejection fraction in the different evaluated periods.ConclusionEvaluations of arterial stiffness by oscillometry and measurement of left ventricular ejection fraction by Doppler echocardiography showed equivalence in the values found, suggesting that the evaluation method of arterial stiffness studied could be used as a marker for cardiovascular adverse events associated with doxorrubicin-based chemotherapy drugs.

Perturbations of Adjuvant Chemotherapy on Cardiovascular Responses and Exercise Tolerance in Patients with Early-Stage Breast Cancer

“…Unlike these previous studies, we found that clinical cardiovascular hemodynamic risk factors such as central and brachial blood pressure, as well as PWV and Pb in both groups, did not change after the chemotherapy, which implies that in the short term, both AC-T and CAF chemotherapy did not appear to exert acute adverse hemodynamic risks ( Table 2 ). Similar to our findings, Souza et al reported that the hemodynamic parameters associated with arterial stiffness were not changed in the early phase of doxorubicin-based chemotherapy [ 52 ]. The discrepancy between our findings and several previous reports may be due to the relatively younger enrolled participants (mean age: 44 years) in this study.…”

The Therapeutic Effects of Ligustrazine in Combination with Other Drugs in Cardiovascular Diseases

“…However, DOX causes acute and chronic toxic adverse effects that are dosage dependent, and cardiotoxicity is a potentially fatal toxic side effect [48,49]. Moreover, arterial stiffness is induced in patients undergoing chemotherapy with DOX, serving as a monitor of cardiovascular events [50]. DOX causes cardiovascular damage through inducing cardiomyocyte death pathways, including autophagy, ferroptosis, pyroptosis, and apoptosis [51].…”

Clinical Exercise Prescription for Cardiovascular Health in Breast Cancer Survivors

“…Moreover, anthracycline-related vascular impairment may occur as a result of chemotherapy side effects 74,75 . For example, adult survivors of breast cancer present increased pulse wave velocities that represent aortic and/or arterial stiffness after anthracycline or trastuzumab chemotherapy [76][77][78] . Increased arterial stiffness is associated with the development of cardiovascular events including atrial fibrillation 79 and stroke 80 in non-cancer populations.…”