Efficacy of Echocardiographic Parameters in Predicting Chemoradiotherapy-Induced Cardiotoxicity in Patients With Breast Cancer

Document Type : Original Article

Authors

1 Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.

2 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Cardio-Oncology Department and Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran.

4 Department of Radiation Oncology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, IR Iran.

5 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

6 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Objective: Using echocardiographic parameters, we sought to predict cardiotoxicity in patients with breast cancer before treatment.
 
Methods: The study recruited 53 left-sided breast cancer patients with no previous history of heart failure or cancer treatment. The patients underwent 2D and 3D echocardiography before and 6 months after the end of treatment. The main criterion for cardiotoxicity was a reduction in posttreatment LVEF exceeding 10% compared with pretreatment. Systolic and diastolic parameters were compared between 2 groups: complicated and noncomplicated. Binary logistic regression was used to predict cardiotoxicity.
 
Results: The patients’ mean age was 49 ± 11.2 years. No statistical differences existed between the groups in demographics and cardiac risk factors at study commencement. Posttreatment, 4 echocardiographic parameters (E/A ratio, sPAP, LVEF, and LVGLS) were significantly changed compared with pretreatment echocardiography. The regression analysis showed that E/A ratio was effective in predicting cardiotoxicity (sensitivity = 68%, specificity = 76%, AUC =77%; and P <0.001).
 
Conclusions: Echocardiography, aside from its usefulness in diagnosing cardiotoxicity, can be valuable in predicting complications, especially in patients with breast cancer at higher risk of cardiotoxicity due to chemotherapy and radiotherapy in the chest wall area. (Iranian Heart Journal 2023; 24(3): 62-69)

Keywords

References

  1. Riis M. Modern surgical treatment of breast cancer. Annals of Medicine and Surgery. 2020; 56:95-107.
  2. Latif J, Mehta S. Adjuvant treatment for breast cancer. Surgery (Oxford). 2021.
  3. Azarfarin R, Sheikhzadeh D, Mirinazhad M, Bilehjani E, Alizadehasl A. Do nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia? Acta Anaesthesiologica Taiwanica. 2011; 49(2):41-5.
  4. Hakim H, Samadikhah J, Alizadehasl A, Azarfarin R. Chronobiological rhythms in onset of massive pulmonary embolism in Iranian population. Middle East J Anesthesiol. 2009; 20:369-75.
  5. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. Journal of the American College of Cardiology. 2020; 76(25):2982-3021.
  6. Ziyaeifard M, Alizadehasl A, Aghdaii N, Rahimzadeh P, Masoumi G, Golzari SE, et al. The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2016; 21.
  7. Cardiovascular diseases (CVDs) 11 June 2021 [Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
  8. Ansari-Ramandi MM, Maleki M, Alizadehasl A, Amin A, Taghavi S, Alemzadeh-Ansari MJ, et al. Safety and effect of high dose allopurinol in patients with severe left ventricular systolic dysfunction. Journal of cardiovascular and thoracic research. 2017; 9(2):102.
  9. Ziyaeifard M, Alizadehasl A, Aghdaii N, Sadeghi A, Azarfarin R, Masoumi G, et al. Heparinized and saline solutions in the maintenance of arterial and central venous catheters after cardiac surgery. Anesthesiology and pain medicine. 2015; 5(4).
  10. Soulat-Dufour L, Addetia K, Miyoshi T, Citro R, Daimon M, Fajardo PG, et al. Normal values of right atrial size and function according to age, sex, and ethnicity: results of the world alliance societies of echocardiography study. Journal of the American Society of Echocardiography. 2021; 34(3):286-300.
  11. Henning RJ, Harbison RD. Cardio-oncology: cardiovascular complications of cancer therapy. Future cardiology. 2017; 13(4):379-96.
  12. Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, et al. Adjuvant trastuzumab in HER2-positive breast cancer. New England journal of medicine. 2011; 365(14):1273-83.
  13. Zamorano JL, Lancellotti P, Rodriguez Munoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). European heart journal. 2016; 37(36):2768-801.
  14. Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popović ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. Journal of the American College of Cardiology. 2013; 61(1):77-84.
  15. Kostakou PM, Kouris NT, Kostopoulos VS, Damaskos DS, Olympios CD. Cardio-oncology: a new and developing sector of research and therapy in the field of cardiology. Heart failure reviews. 2019; 24(1):91-100.
  16. Alizadehasl A. Cardio-Oncology. Practical Cardiology. 1. 2 ed. Elsevier: Elsevier; 2021.
  17. Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. Journal of the National Cancer Institute. 2010; 102(1):14-25.
  18. Jensen BV, editor Cardiotoxic consequences of anthracycline-containing therapy in patients with breast cancer. Seminars in oncology; 2006: Elsevier.
  19. S Gillespie H, J McGann C, D Wilson B. Noninvasive diagnosis of chemotherapy related cardiotoxicity. Current cardiology reviews. 2011; 7(4):234-44.
  20. Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. Journal of the American College of Cardiology. 2009; 53(24):2231-47.
  21. Baratta S, Damiano M, Marchese M, Trucco J, Rizzo M, Bernok F. Serum markers, conventional Doppler echocardiography and two-dimensional systolic strain in the diagnosis of chemotherapy-induced myocardial toxicity. Rev Argent Cardiol. 2013; 81(2):139-46.
  22. Mornoş C, Petrescu L. Early detection of anthracycline-mediated cardiotoxicity: the value of considering both global longitudinal left ventricular strain and twist. Canadian Journal of Physiology and Pharmacology. 2013; 91(8):601-7.
  23. Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circulation: Cardiovascular Imaging. 2012;5(5):596-603.
Iranian Heart Journal
Volume 24, Issue 3
July 2023
Pages 62-69

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