Abstract 17966: Left Ventricular Systolic Dysfunction at Baseline and Follow-up is Associated with Long-term Survival in Chemotherapy Treated Breast Cancer Patients
Introduction: Chemotherapy agents commonly used in the treatment of breast cancer are associated with unique and varying degrees of myocardial injury, often measured as declines in left ventricular ejection fraction (LVEF). However, whether pre-chemotherapy LVEF or change in LVEF post-chemotherapy impacts survival in breast cancer patients remains poorly defined.
Hypothesis: We assessed the hypothesis that pre-chemotherapy LVEF and/or change in LVEF following the completion of chemotherapy are associated with reduced long-term survival in breast cancer patients.
Methods: We identified breast cancer patients treated with any type of chemotherapy at Duke University Medical Center (DUMC) from 1995-2010. Using the identified cohort, we linked LVEF in the DUMC echocardiography and nuclear cardiology databases with demographic and survival analyses in the DUMC clinical and administrative databases.
Results: There were 3,520 breast cancer patients who received chemotherapy at DUMC from 1995-2010. Among all patients receiving chemotherapy, 1,620 (mean 51 ± 11 years old) underwent non-invasive baseline LVEF evaluation by Echo (n = 816) or MUGA (n = 804). The pre-chemotherapy LVEF was abnormal (< 55%) among 89 (5.5%). Median follow-up was 5.7 years (IQR 3.0 - 9.5 years); 184 patients died during follow-up. After adjusting for age and race, baseline LVEF was associated with excess mortality (HR = 1.308; 95% CI = 1.140-1.501; p = 0.001); each 5% decrement of baseline LVEF from normal (≥ 55%) was associated with a 31% increase in mortality during follow-up. Among the 440 patients who also underwent a follow-up LVEF within 1 year after completing chemotherapy, 50 (11.4%) patients had an abnormal follow-up LVEF. Decreased LVEF on post-chemotherapy studies was associated with an increase in mortality (HR per 5% decrease = 1.167; 95% CI = 1.019-1.336; p = 0.026).
Conclusions: Lower LVEF at baseline and LVEF within 12 months of treatment are each significantly associated with increased risk of all-cause mortality in breast cancer patients receiving chemotherapy. Further research is needed to define optimal preventive and treatment strategies in these at risk patients.
- © 2012 by American Heart Association, Inc.