Abstract 17757: Early Cardiac Remodeling in Response to Chemotherapy in Early Stage Breast Cancer Patients With Low Cardiac Risk: A Prospective Cardiac Magnetic Resonance Imaging Study
INTRODUCTION: The currently accepted guidelines for cardiotoxicity fail to detect early cardiac remodeling in low risk breast cancer patients receiving adjuvant chemotherapy.
HYPOTHESIS: Early cardiac remodeling will occur without a decline a systolic function as defined by current guidelines.
METHODS: We prospectively studied 20 patients, of which 17 completed study (mean age 49 ± 12 years), diagnosed with early breast cancer (stage I-IIb) that were treated with either low dose doxorubicin or trastuzumab in the adjuvant setting. Cardiac magnetic resonance imaging (CMR), 2D- and 3D-echocardiography, strain imaging and cardiac biomarkers were obtained at 4 different time-points: baseline, during chemotherapy, 2 weeks post chemotherapy, and 6 months post chemotherapy. Additionally, a questionnaire regarding heart failure symptoms was completed by patients at each time point. Statistics were analyzed by a linear mixed model.
RESULTS: Left ventricular (LV) end-diastolic and end-systolic volumes increased significantly over time (table). LV ejection fraction decreased over time by CMR (table). There was no visual evidence of myocardial edema or fibrosis by late gadolinium enhancement. Troponin I, C-reactive protein, and brain natriuretic peptide as well as well as echocardiography strain parameters did not change significantly.
CONCLUSION: Significant early volumetric and functional changes were detected by CMR in low cardiac risk breast cancer patients receiving adjuvant chemotherapy. The decline in LVEF and LV volumetric changes occurred despite the absence of heart failure symptoms and biomarkers of cardiac injury. We conclude that this cardiac remodeling may represent an early cardiac response to chemotherapy and future studies are needed to evaluate the prognostic significance of these findings.
- © 2013 by American Heart Association, Inc.