The effect of prophylactic carvedilol on subclinical left ventricular dysfunction after 1 cycle FAC chemotherapy in breast cancer patients

Abstract

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.

Cardiac computed tomography-derived extracellular volume fraction in the identification of cardiotoxicity: Another emerging imaging option

“…For most cancer-related treatments, baseline and serial echocardiography examinations are commonly performed as first line imaging for a timely identification of early development of cardiotoxicity. Cardiotoxicity, as determined with echocardiography, is defined as new onset of left ventricular systolic dysfunction with a decrease in left ventricular ejection fraction (LVEF) of ≥10% to a value <50% [9] . In order to identify and characterize subclinical cardiotoxicity at its early stage, speckle-tracking echocardiography with myocardial strain assessment is concurrently applied.…”

“…A relative reduction in GLS ≥ 15% during cancer treatment from baseline is suggestive of early functional alterations before a drop in LVEF may ensue. It is important to keep in mind that the identification of subclinical and/or clinically-manifest left ventricular dysfunction likely leads to a change in the selection of a chemotherapeutic agent, the installation of cardioprotective treatment, and the timing of repeat monitoring imaging [9] , [10] . In case of poor echocardiographic image quality, cardiac magnetic resonance (CMR) is commonly conducted for the assessment of global LVEF and myocardial strain imaging with the use of tagging, displacement encoding with stimulated echoes (DENSE) and strain-encoded (SENC) imaging [1] , [11] .…”