Abstract 3566: Early Contractility Impairment During Anthracycline Treatment Revealed by Serial Tissue Doppler Echocardiography in Presence of Negative Biochemical Markers
BACKGROUND: The prognosis of cardiotoxicity induced by anthracycline treatment (ACT) is poor, and a sensitive non-invasive method for its early detection is strongly required. Systolic isovolumic acceleration (IVA) was reported as the ideal index, not affected by preload and afterload and providing a reliable assessment of contractility when examined, in animal studies, against invasive standards.
METHODS: We enrolled 12 women with breast cancer (mean [±SD] age 53±17 years) who underwent adjuvant therapy with i.v. epirubicine (EPI; cumulative dose 400±20mg/m2) administered in 4±1 months. Women were studied by means of conventional echocardiography and tissue Doppler imaging (TDI). Plasma levels of brain natriuretic peptide (BNP) and troponin I (TI) were assessed. Patients underwent investigation before chemotherapy and 1 and 7 days after each new 100mg/m2 dose of EPI. We evaluated longitudinal function using pulsed TDI at the basal segments of the left ventricular (LV) septum. IVA, isovolumic relaxation time (IVRT), peak velocities in systole (Sm), early (Em) and late diastole (Am) were measured. RESULTS: During EPI therapy, we observed an impairment of diastolic function, significant one week after the 300±20mg/m2 dose with a decrease of E/A, conventional (1.16±0.31 vs. 0.92±0.24; p<0.05) and TDI (1.05±0.3 vs. 0.78±0.27; p<0.05). On the other hand, we observed an earlier impairment of IVA (1.33±0.2 vs. 1.99±0.9; p<0.05) and of IVRT (89.2±9.7 vs. 65.2±6.1; p,0.001), already significant at 200±20mg/m2 dose. All patients had a normal Sm, as well as LV ejection fraction at the end of therapy. Notably, we didn’t found any change of BNP and TI levels throughout the treatment.
CONCLUSION: Our data show, for the first time, an impairment of LV contractility as the earliest sign of EPI-induced cardiotoxicity. This event occurred, unexpectedly, at level of EPI 200mg/m2 dose, believed to be pretty low by oncologists, and without biochemical markers changes from baseline values.