Noninvasive early detection of anthracycline‐induced cardiotoxicity in patients with hematologic malignancies using the phased tracking method

Abstract

Anthracyclines are among the most effective and widely used anticancer drugs; however, their use is limited by serious cardiotoxicity. Early detection is necessary to prevent the high mortality rate associated with heart failure (HF). We evaluated cardiac function in 142 patients using conventional echocardiography and the phased tracking method (PTM), which was measured using the minute vibration and the rapid motion components, neither of which is recognized in standard M‐mode nor in tissue Doppler imaging. For systolic function comparison, we compared left ventricular ejection fraction (LVEF) in conventional echocardiography with the average velocity of ventricular septum myocytes (Vave) in the PTM. The Vave of 12 healthy volunteers was 1.5 (m/s)/m or more. At baseline of 99 patients, there was a positive correlation between LVEF and Vave in all patients. There were no significant differences in baseline cardiac function between patients with and without HF. There was a negative correlation between the cumulative anthracycline dose and LVEF or Vave among all patients. We determined that Vave 1.5 (m/s)/m was equivalent to LVEF 60%, 1.25 (m/s)/m to 55%, and 1.0 (m/s)/m to 50%. During the follow‐up period, there was a pathological decrease in LVEF (<55%) and Vave (<1.25 m/s/m) in patients with HF; decreases in Vave were detected significantly earlier than those in LVEF (P < 0.001). When Vave declined to 1.5 (m/s)/m or less, careful continuous observation and cardiac examination was required. When Vave further declined to 1.0 (m/s)/m or lower, chemotherapy was postponed or discontinued; thus, serious drug‐induced cardiomyopathy was avoided in patients who did not relapse. The PTM was superior to echocardiography for early, noninvasive detection and intermediate‐term monitoring of left ventricle systolic function associated with anthracycline chemotherapy, among patients with hematologic malignancies. The PTM was an effective laboratory procedure to avoid the progression to serious cardiomyopathy.

Incidence and risk factors associated with development of clinical cardiotoxicity in dogs receiving doxorubicin

“…Echocardiography also should be used, particularly in breeds at risk for developing DCM, to obtain a baseline fractional shortening and monitor for decreases. In humans, patients can be monitored for cardiotoxicity using echocardiography and ECG, and more advanced techniques such as radionuclide angiocardiography, phased‐tracking methods, and endomyocardial biopsy also have been reported . The preferred echocardiographic method of monitoring left ventricular function in humans is 3‐dimensional echocardiography, as opposed to 2‐dimensional echocardiography (2DE), which is used in most veterinary hospitals.…”

“…Three‐dimensional echocardiography is more accurate at detecting changes in ejection fraction and systolic function and also has been associated with better reproducibility than 2DE . Although detectable deterioration in heart function, such as decreases in left ventricular ejection fraction or decreases in velocity of the ventricular septum myocytes, and histopathologic changes consistent with cardiotoxicity typically result in the recommendation to discontinue DOX, there unfortunately is insufficient data to develop evidence‐based recommendations for DOX‐induced cardiotoxicity even in humans . Serum cardiac troponin I concentration has been used as a marker in humans for myocardial damage secondary to DOX .…”

Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

“…All echocardiographic images were acquired with mean frame rates of 70–90 frame/sec and digitally stored for 3 cardiac cycles. This method has been described in detail [ 7 – 9 ] and involves tracking speckles from frame- to- frame. RV strain parameters: (RV global longitudinal strain [GLS], RV free wall strain [FWS]) and RV fractional area change [FAC] (Figs.…”

A Bibliometric Review of Publications on Oxidative Stress and Chemobrain: 1990–2019

“…DOX and anthracyclines are among the drugs whose cardiotoxicity is most widely described [66]. Depending on the dose, pharmacokinetics, and type of anthracycline used, myocardial cell loss and/or functional impairment may occur [67,68]. Oxidative stress is thought to be primarily responsible for DOX cardiotoxicity [69].…”