Abstract 16995: Early Quantification of Left Ventricular Time-Volume Relation Detects Early Cardiotoxicity in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Prospective Cardiac Magnetic Resonance Imaging Study
Background: Current guidelines recommend serial monitoring of systolic function by echocardiography in breast cancer patients receiving adjuvant chemotherapy. However, limited data exist on diastolic dysfunction as a form of cardiotoxicity in this population.
Hypothesis: Quantification of left ventricular (LV) time-volume relation can detect early diastolic dysfunction as a response to chemotherapy despite normal systolic function.
Methods: Twenty patients diagnosed with stage I - III breast cancer receiving adjuvant anthracyclines or trastuzumab therapy were prospectively enrolled from 2008 to 2013. Mean age and body mass index at study entry was 49.1±12.4 and 26.6±5.5, respectively. All patients underwent echocardiography , biomarkers , and cardiac magnetic resonance imaging at four time points: baseline, after the second cycle of chemotherapy, 2 weeks after last cycle of chemotherapy, and 6 months after last cycle of chemotherapy. Statistical analysis was done using linear mixed models.
Results: LV ejection fraction (LVEF, %) decreased significantly from 64.15±5.30 to 60.41±5.77, p<0.00. Normalized peak ejection rate decreased significantly from 3.09±0.78 to 2.51±0.55, p<0.02 (table). Time to peak filling rate (TPFR, sec) decreased significantly from 241.64±149.21 to 159.54±79.67 (table, graph). LV mass did not significantly change over time. No fibrosis was detected.
Conclusion: LV systolic ejection and diastolic filling rates significantly changed despite a declining, but normal LVEF in breast cancer patients on adjuvant chemotherapy. These changes to the LV time-volume relation may indicate an early sign of cardiotoxicity.
- © 2013 by American Heart Association, Inc.