Abstract 14745: Chemotherapy Causes Diastolic More Than Systolic Dysfunction Without a Change in Myocardial Tissue Characteristics
BACKGROUND: Anthracyclines can cause cardiotoxicity and heart failure but predictors of a decline in ejection fraction (EF) and diastolic dysfunction are lacking. . We hypothesized that changes in tissue distribution of gadolinium (Gd) and/or strain identified using (Gd)-enhanced cardiac magnetic resonance (CMR) early during chemotherapy would precede any drop in EF or change in diastolic function.
METHODS: Patients with newly diagnosed malignancy on anthracyclines and/or Herceptin with normal baseline LV EF were studied. CMR was performed before, 19 ± 25 days after the 1st round, and 62 ± 55 days after chemotherapy completion. CMR included measures of LV systolic and diastolic function, strain (cine displacement encoded stimulated echoes), scar (late Gd enhancement), edema (T2-weighted imaging) and the partition coefficient (λ) and volume of distribution (Vd) of Gd by T1 mapping. The latter was calculated using images pre and 5, 10, 15 and 20 min post-Gd infusion.
RESULTS: Of 25 patients recruited to date, 19 were on anthracyclines and 6 on Herceptin. Eighteen (72%) had breast cancer, 6 (24%) leukemia/lymphoma, and 1 (4%) osteosarcoma. Mean age was 50 ± 11yrs (84% F). Twenty underwent 1st post-chemotherapy study and 9 have completed the last, only one of whose EF fell below normal, to 47%. (see Table 1 for results) Peak circumferential strain improved after chemotherapy. No patient demonstrated new myocardial edema or scar. 45% (9/20) of the patients developed diastolic dysfunction based on abnormal e/a ratio (<0.99 or >2). However no significant differences in λ, Vd or strain were seen in those with or without diastolic dysfunction.
CONCLUSION: Anthracyclines and/or Herceptin appear to alter LV diastolic more than systolic function. Although further follow-up is needed, little myocardial injury has been identified to date despite the use of sensitive methods such as T1 mapping and strain imaging.
- © 2013 by American Heart Association, Inc.