Highlights
- •What is already known about this subject?
- •Some studies have found early changes in several diastolic function parameters in patients exposed to Anthracycline therapy. Incidence of late-onset cardiotoxicity in adult population with breast cancer is scarce.
- •What does this study add?
- •We characterize the incidence of late-onset cardiotoxicity in a cohort of breast-cancer patients undergoing Anthracycline treatment. Development of diastolic dysfunction early after chemotherapy is a strong predictor of anthracycline cardiotoxicity.
- •How might this impact on clinical practice?
- •Evaluation of diastolic function is a simple diagnostic measurement that may help us to discriminate patients at higher risk of developing anthracycline cardiotoxicity.
Abstract
Introduction
Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab
in breast cancer patients. Data on longitudinal studies about early and late onset
cardiotoxicity in this group of patients is scarce. The objective of the present study
was to assess predictors of early and late onset cardiotoxicity in patients with breast
cancer treated with A.
Methods
100 consecutive patients receiving anthracycline-based chemotherapy (CHT) to treat
breast cancer were included in this prospective study. All patients underwent evaluation
at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years after
the beginning of CHT. Clinical data, systolic and diastolic echo parameters and cardiac
biomarkers including high sensitivity Troponin T (TnT), N-terminal pro-brain natriuretic
peptide (NT-proBNP) and Heart-type fatty acid binding protein (H-FABP) were assessed.
Results
Mean doxorubicin dose was 243 mg/m2. Mean follow-up was 51.8 ± 8.2 months. At one-year
incidence of anthracycline related-cardiotoxicity (AR-CT) was 4% and at the end of
follow-up was 18% (15 patients asymptomatic left ventricular systolic dysfunction,
1 patients heart failure and 2 patients a sudden cardiac death). Forty-nine patients
developed diastolic dysfunction (DD) during first year. In the univariate analysis
DD during first year was the only parameter associated with AR-CT (Table 1). In the logistic regression model DD was independently related with the development
of AR-CT, with an odds ratio value of 7.5 (95% CI 1.59–35.3).
Conclusions
Incidence of late-onset cardiotoxicity is high but mostly subclinical. Diastolic dysfunction
early after chemotherapy is a strong predictor of anthracycline cardiotoxicity.
Keywords
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Article info
Publication history
Published online: April 18, 2023
Accepted:
April 16,
2023
Received in revised form:
April 1,
2023
Received:
October 24,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
