Abstract 12899: Evaluation of Time Course of Left Ventricular Dysfunction by Cardiotoxicity of Anthracycline
Background: Anthracyclines cause dose-dependent left ventricular (LV) myocardial dysfunction associated with a poor prognosis. Therefore, interest is high in the time course of LV dysfunction in these patients as a result of the cardiotoxicity of anthracyclines because of its potential for predicting future global LV dysfunction.
Method: We designed the following two study models. Study 1: Forty patients with preserved ejection fraction (EF) of 65±4% (all ≥55%) after receiving anthracycline chemotherapy (282±134mg/m2) were recruited. Time elapsed from final anthracycline administration and the echocardiographic examination was 14±24 months. Twenty age- and gender-matched normal volunteers were studied for comparisons. Study 2: Eight consecutive patients prospectively recruited before anthracycline chemotherapy, and followed 6 and 12 months after anthracycline administration. For both study models, three-dimensional (3-D) radial, circumferential and longitudinal myocardial function was quantified as a peak global strain curve using 3-D speckle-tracking from all 16 LV segments, and LV endocardial area change ratio (area strain) was quantified as peak global area strain curve (3D-GAS) to determine LV endocardial function.
Results: Study 1: Only 3D-GAS and peak 3-D global circumferential strains of the anthracycline group were significantly worse than those of the control group (-42.7±2.9% vs. -45.8±4.3% and -31.1±3.5% vs. -34.4±4.2%, respectively; both p=0.002) even though global LV systolic and diastolic functions were similar (EF; 65±4% vs. 66±3%, E/E’; 8.3±2.4 vs. 8.9±3.2). It was noteworthy that multivariate analysis showed only 3D-GAS (β=0.365, p=0.024) was independently associated with cumulative anthracycline dose. Study 2: EF significantly decreased from baseline to 6 months and 12 months after anthracycline administration (69.5±2.8%, 65.8±3.9%, 64.8±4.3%, p=0.049), but E/E’ did not.
Conclusions: Patients who received anthracycline have LV endocardial dysfunction even if global LV function was preserved. Early detection of minor LV myocardial dysfunction may thus play a clinical role in predicting future global LV systolic dysfunction.
- © 2013 by American Heart Association, Inc.