The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index

Ayhan, Selim; Özdemi̇r, Kurtuluş; Kayrak, Mehmet; Bacaksız, Ahmet; Vatankulu, Mehmet Akıf; Eren, Orhan Önder; Koç, Fatih; Duman, Çetin; Güleç, Hakan; Demir, Kenan; Arı, Hatem; Sönmez, Osman; Gök, Hasan

doi:10.5603/cj.2012.0066

Cited by 14 publications

(16 citation statements)

References 18 publications

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“…It was recently reported that diastolic dysfunction can precede systolic dysfunction and the risk of diastolic dysfunction in RV is higher than that of LV [14,25]. In contrast, another recent study reported normal RV function and high LV MPI values in patients with early-stage anthracycline-induced cardiotoxicity [4].…”

Section: Discussionmentioning

confidence: 95%

Evaluation of Cardiotoxicity by Tissue Doppler Imaging in Childhood Leukemia Survivors Treated with Low-Dose Anthracycline

et al. 2015

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Improvement in long-term survival in patients with acute childhood leukemia has led to the need for monitorization of chemotherapy-related morbidity and mortality. This study included 60 patients with acute lymphoblastic leukemia that were in remission for at least 2 years and 30 healthy controls. Systolic and diastolic function of myocardium was evaluated using conventional echocardiography and tissue Doppler imaging of the left ventricle, interventricular septum and right ventricle. Median age of patients was 11.7 years (range 10-14.9 years), and the median duration of remission was 4 years (range 2.5-5 years). All patients were treated with a low cumulative dose of adriamycin (100 mg/m(2)) according to the St. Jude Total-XIIIA protocol. The ejection fraction (EF) and fractional shortening were normal in the patient and control groups, even though EF values were significantly lower in the patients (69.5 ± 2.3 vs. 72.7 ± 3 %, P < 0.01). Myocardial systole (S m), early diastole (E m) and late diastole (A m) velocities in all segments of the myocardium were significantly lower in the patient group (P < 0.01 for all segments). Cardiotoxicity was noted in all segments of the myocardium in the patient group, despite the fact that they were all treated with a low cumulative dose of adriamycin. Based on these findings, we think that there is no safe dose for anthracyclines and periodic echocardiographic evaluation of both the left and right ventricles must be performed in all patients treated with anthracyclines, even at low doses.

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Section: Discussionmentioning

confidence: 95%

Evaluation of Cardiotoxicity by Tissue Doppler Imaging in Childhood Leukemia Survivors Treated with Low-Dose Anthracycline

et al. 2015

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“…The Tei index was calculated as: Tei = (ICT ? IRT)/ET, for MPI of the RV using PW-TDI at tricuspid annulus, for LV using PW-TDI at the lateral mitral annulus [1,20]. To reduce the effect of respiration on tissue velocities and as breath-holding is not applicable in young children, three cardiac cycles were recorded and the average velocity and average times were calculated.…”

Section: Methodsmentioning

confidence: 99%

Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age

et al. 2015

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Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age-group are scarce. The objective of the study was to assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). The study included 37 consecutive patients diagnosed as ASD secundum by transthoracic echocardiography and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt, from October 2010 to July 2013. Thirty-seven age- and sex-matched controls were selected. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and lateral mitral annulus, and myocardial performance index (MPI) was calculated at 1-, 3-, 6- and 12-month post-device closure. Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards the age, gender, weight or BSA. TDI showed that patients with ASD had significantly prolonged isovolumetric contraction, relaxation time and MPI compared with control group. Decreased tissue Doppler velocities of RV and LV began at one-month post-closure compared with the controls. Improvement in RVMPI and LVMPI began at 1-month post-closure, but they are still prolonged till 1 year. Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure, but did not completely normalize even after 1 year of follow-up by tissue Doppler imaging.

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“…Given the thinner structure of the RV with fewer myofibrils, the RV may also be susceptible to damage by cardiotoxic therapy. Several studies have shown that RV wall motion abnormalities [ 13 ] or functional abnormalities [ 12 , 14 ] occur during cancer therapy ; however, this finding has not been universally observed [ 11 , 15 ]. The presence of RV dysfunction at the time of LV cardiotoxicity and whether it has prognostic implications has not been examined.…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

Calleja

Poulin

Khorolsky

et al. 2015

Journal of Oncology

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Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity. Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls. Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%, P = 0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3%) was seen in 40% (n = 12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n = 11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant. Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

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The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index

Cited by 14 publications

References 18 publications

Evaluation of Cardiotoxicity by Tissue Doppler Imaging in Childhood Leukemia Survivors Treated with Low-Dose Anthracycline

Evaluation of Cardiotoxicity by Tissue Doppler Imaging in Childhood Leukemia Survivors Treated with Low-Dose Anthracycline

Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age

Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

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