Abstract 198: Subclinical Cardiovascular Toxicity of Anthracyclines Identified With Cardiovascular Magnetic Resonance Imaging
Background: Anthracycline chemotherapy (AC) is associated with latent congestive heart failure (CHF), but at present there are no established early markers of cardiovascular injury that forecast CHF.
Methods: We performed a longitudinal cohort study of 42 adult AC recipients (51±11.2 years, range 22–76 years) and 13 age matched controls. Each AC recipient underwent cardiovascular magnetic resonance imaging (CMR) at baseline (before AC) and at 1, 3 and 6 months after AC. Each control participant underwent CMR twice at baseline and at 3 months. During CMR, thoracic aortic pulse wave velocity (PWV) and left ventricular ejection fraction (LVEF) were measured according to published standards.
Results: Twenty-eight participants received doxorubicin, while 14 received daunorubicin. Mean cumulative doses of anthracyclines at the 1, 3, and 6 month follow-up visits were 119.6±78.2, 204.6±82.4, and 236.7±100.3 mg/m2, respectively. At the 1 month follow-up visit, all cancer participants experienced significantly increased aortic stiffness compared to baseline (p<0.0001) and further increased aortic stiffness at the 3 and 6 month follow-up visits compared to baseline (p<0.0001 both) (Figure⇓). LVEF decreased at the 3 and 6 month follow-up visits (p=0.016 and p<0.009, respectively) (Figure⇓). PWV and LVEF remained similar in the control participants (from 4.5±0.9 m/s to 4.6±0.9 m/s, p=0.78 and from 60.9±5.2% to 59.9±4.1%, p=0.69, respectively).
Conclusion: Low doses of anthracycline chemotherapy diminished LVEF and increased aortic stiffness, two measures of subclinical cardiovascular disease and indicators of future cardiovascular events.