Anthracyclines and regional myocardial damage in breast cancer patients. A multicentre study from the Working Group on Drug Cardiotoxicity and Cardioprotection, Italian Society of Cardiology (SIC)

Abstract

Aims In breast cancer (BC) patients treated with anthracyclines-based therapies, we aim at assessing whether adjuvant drugs impact cardiac function differently and whether their cardiotoxicity has a regional pattern. Methods and results In a multicentre study, 146 BC patients (56 ± 11 years) were prospectively enrolled and divided into three groups according to the received treatments: AC/EC-Group (doxorubicin or epirubicin + cyclophosphamide), AC/EC/Tax-Group (AC/EC + taxanes), FEC/Tax-Group (fluorouracil + EC + taxanes). Fifty-six patients of the total cohort also received trastuzumab. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated before starting chemotherapy (T0), at 3 months (T3), at 6 (T6), and 12 months (T12). A ≥10% drop of EF, while remaining within the normal range, was reached at T6 in 25.3% of patients from the whole cohort with an early decrease only in FEC/Tax-Group (P = 0.04). A ≥15% GLS reduction was observed in many more (61.6%) patients. GLS decreased early both in the whole population (P < 0.001) and in the subgroups. The FEC-Tax Group showed the worst GLS at T6. Trastuzumab further worsened GLS at T12 (P = 0.031). A significant reduction of GLS was observed in all LV segments and was more relevant in the anterior septum and apex. Conclusions The decrease of GLS is more precocious and pronounced in BC patients who received FEC + taxanes. Cardiac function further worsens after 6 months of adjuvant trastuzumab. All LV segments are damaged, with the anterior septum and the apex showing the greatest impairments.

Myocardial edema during chemotherapy for gynecologic malignancies: A cardiac magnetic resonance T2 mapping study

“…Additionally, our study revealed that the increase in myocardial T2 of patients was more pronounced in the apical slice than in the middle and basal slices. Although similar data haven't been reported about the regional distribution of myocardial T2, published literatures have demonstrated the greatest motion impairments at heart apex in patients treated with chemotherapy (26,27). Taken together, we speculated that apical myocardium is more vulnerable to chemotherapy.…”

“…Taken together, we speculated that apical myocardium is more vulnerable to chemotherapy. The potential causes might be the increased exposure of terminal circulation regions to chemotherapy drugs or the differential local activation of signal transduction ( 26 ), but the exact mechanism needs further exploration.…”

Early Predictive Value of NT-proBNP Combined With Echocardiography in Anthracyclines Induced Cardiotoxicity

“…The cardiotoxicity caused by anthracyclines is generally divided into acute, chronic and delayed, which represent different pathological processes of myocardial injury. Because the early clinical manifestations of cardiotoxicity are not obvious, once it is diagnosed, obvious myocardial lesions, with poor prognosis and high mortality (17)(18)(19). Therefore, during chemotherapy, it is necessary to monitor the cardiac status and toxicity of anthracyclines, find out and intervene in time, and improve the survival rate of patients after chemotherapy.…”

Role of Myocardial Strain Imaging by Echocardiography for the Early Detection of Anthracyclines-Induced Cardiotoxicity

“…Also, Zito et al [ 25 ], Dogru et al [ 20 ], D Mohty et al [ 26 ] and Laufer-Perl et al [ 27 ] Poterucha et al [ 28 ] and Kang et al [ 29 ], concluded that the use of the use of GLS on a regular basis during treatment could lead to an early detection of cardiotoxicity.…”