Early Detection of Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer

Florescu, Maria; Magda, L.; Enescu, Oana Aurelia; Jinga, Dan; Vinereanu, Dragoş

doi:10.1016/j.echo.2013.10.008

Cited by 91 publications

(85 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, in late survivors of cancer with normal LV function determined by conventional echocardiography, measures of global radial and circumferential strain were consistently abnormal. Florescu et al, reported similar results in 14 patients with breast cancer that developed Epirubicin-Induced Cardiotoxicity [10]. Likewise, GLS has shown to be an important predictor of mortality in routine follow-up of cancer patients with normal ejection fractions receiving chemotherapy [11].…”

Section: Introductionmentioning

confidence: 89%

Potential usefulness of diastolic parameters measured by strain imaging echocardiography in the early prediction of chemotherapy-induced cardiotoxicity

Hernández-Suárez

López‐Candales

2017

Medical Hypotheses

View full text Add to dashboard Cite

Over the past decades, chemotherapy has significantly increased the overall prognosis and survival of several patients diagnosed with cancer. However, the usefulness of some chemotherapeutic agents has been hindered by a collateral dose-dependent cardiotoxicity. To date, although extensive efforts have been directed to the early detection of subclinical toxicity in patients treated with these drugs, it remains unclear which approach would be best in order to prevent chemotherapy-induced cardiotoxicity (CIC). For many years, conventional echocardiography has been among preferred noninvasive imaging modality to monitor left ventricular ejection fraction (LVEF) in patients undergoing chemotherapy. Unfortunately, a significant reduction in LVEF is not recognized early on after chemotherapy-induced myocardial damage. Moreover, delayed recognition has been associated with poor recovery potential and poor clinical outcome. Thus, there is a critical need to identify early, reliable parameters of subclinical injury. Myocardial deformation imaging, also known as strain imaging echocardiography (SIE), is becoming readily available for advanced routine echocardiography and has shown value in detecting subclinical ventricular dysfunction in several clinical scenarios. Abnormalities in systolic deformation parameters have been identified as early manifestation but left ventricular diastolic properties remain less well defined. We hypothesize that onset as well as progression of cardiotoxicity not only should disturb deformation curves of myocardial contraction, but also relaxation. Hence, SIE may detect subtle myocardial changes in diastole that could be of potential benefit in the early prediction of CIC. If this premise is proven correct, the use of a standardized advanced echocardiographic imaging protocol using both, systolic and diastolic strain imaging, will prove to be a powerful noninvasive tool as baseline and follow-up of these patients. Furthermore, it will foster the developing of more effective screening strategies in at risk cancer survivor populations, or identify the best time to start cardioprotective therapy to prevent CIC. Also, this experience might be extrapolated to other non-oncologic patient population in need of a surveillance tool to early recognize cardiac injury secondary to the use of cardiotoxic medications.

show abstract

Section: Introductionmentioning

confidence: 89%

Potential usefulness of diastolic parameters measured by strain imaging echocardiography in the early prediction of chemotherapy-induced cardiotoxicity

Hernández-Suárez

López‐Candales

2017

Medical Hypotheses

View full text Add to dashboard Cite

show abstract

“…Although pegylated liposomal doxorubicin may have reduced cardiotoxicity when compared with standard doxorubicin, changes in longitudinal and radial strain were noted after six cycles of treatment in elderly patients with breast cancer [79]. In another study of breast cancer, patients receiving epirubicin showed that a decrease in longitudinal strain after cycle 3 predicted cardiotoxicity after cycle 6 (sensitivity 84%, specificity 80%) [80]. Strain imaging may also be useful in tailoring chemotherapy doses and regimens to the individual patient to prevent CTRCD (Table 2) [81].…”

Section: Echocardiographymentioning

confidence: 95%

Strategies for Early Detection of Cardiotoxicities from Anticancer Therapy in Adults: Evolving Imaging Techniques and Emerging Serum Biomarkers

2015

View full text Add to dashboard Cite

Significant advances have been made in detecting cancer therapeutics-related cardiac dysfunction with serum biomarkers, cardiovascular MRI, echocardiography and multi-modality approaches. Serum biomarkers, notably cardiac troponins and natriuretic peptides, have been evaluated for their prognostic ability in predicting left ventricular dysfunction. Imaging modalities, such as cardiovascular MRI and echocardiography, have been used for cardiac surveillance of patients with cancer undergoing chemotherapy. Developments in imaging, specifically myocardial deformation imaging, also known as strain, have been shown to be sensitive tools in detecting early changes in cardiac function. This review aims to synthesize the evidence that supports emerging serum biomarkers and complementary imaging modalities that continue to enhance the detection of cancer therapeutics-related cardiac dysfunction.

show abstract

“…Furthermore, a decrease in longitudinal strain after the third cycle of epirubicin was identified as the best independent and accurate predictor of cardiotoxicity after completion of epirubicin-induced cardiotoxicity [66]. …”

Section: Clinical Applicationsmentioning

confidence: 99%

Strain Imaging Echocardiography: What Imaging Cardiologists Should Know

López‐Candales

Hernández-Suárez

2017

CCR

View full text Add to dashboard Cite

Despite recent advances in clinical imaging, echocardiography remains as the most accessi-ble and reliable noninvasive. Since knowledge of left ventricular systolic function remains so critically important in determining prognosis; every effort should be made to prevent subjective estimations. The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics; but also allows for early detection of subclinical left ventricular dysfunction. This review outlines the basic concepts of strain imaging to better understand the mechanism of myocardial function as well their applicability in the least common cardiac diagnosis among current clinical practice.

show abstract

Early Detection of Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer

Cited by 91 publications

References 41 publications

Potential usefulness of diastolic parameters measured by strain imaging echocardiography in the early prediction of chemotherapy-induced cardiotoxicity

Potential usefulness of diastolic parameters measured by strain imaging echocardiography in the early prediction of chemotherapy-induced cardiotoxicity

Strategies for Early Detection of Cardiotoxicities from Anticancer Therapy in Adults: Evolving Imaging Techniques and Emerging Serum Biomarkers

Strain Imaging Echocardiography: What Imaging Cardiologists Should Know

Contact Info

Product

Resources

About