Concetta Zito1, Roberta Manganaro1, Maurizio Cusmà Piccione1, Rosalinda Madonna2, Ines Monte3, Giuseppina Novo4, Valentina Mercurio5, Luca Longobardo1, Christian Cadeddu Dessalvi6, Martino Deidda6, Pasquale Pagliaro7, Paolo Spallarossa8, Rossella Costantino1, Mariacarmela Santarpia9, Giuseppe Altavilla9, Scipione Carerj1, Carlo Gabriele Tocchetti5,10. 1. Department of Clinical and Experimental Medicine - Cardiology Unit, University of Messina, Messina, Italy. 2. Department of Surgical, Medical, Molecular and Critical Area Pathology, Institute of Cardiology, University of Pisa, 56124, Pisa, Italy. 3. Department of General Surgery and Medical-Surgery Specialities- Cardiology, University of Catania, Catania, Italy. 4. Department of Cardiology, University of Palermo, Palermo, Italy. 5. Department of Translational Medical Sciences, Federico II University, Naples, Italy. 6. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 7. Department of Clinical and Biological Sciences, University of Torino, Turin, Italy. 8. Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy - Italian IRCCS Cardiovascular Network. 9. Department of Human Pathology of Adult and Evolutive Age "G. Barresi" Medical Oncology Unit, University of Messina, Messina, Italy. 10. Interdepartmental Center of Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy.
Abstract
AIMS: In breast cancer (BC) patients treated with anthracyclines-based therapies, we aim at assessing whether adjuvant drugs impact cardiac function differently and whether their cardiotoxicity has a regional pattern. METHODS AND RESULTS: In a multicentre study, 146 BC patients (56 ± 11 years) were prospectively enrolled and divided into three groups according to the received treatments: AC/EC-Group (doxorubicin or epirubicin + cyclophosphamide), AC/EC/Tax-Group (AC/EC + taxanes), FEC/Tax-Group (fluorouracil + EC + taxanes). Fifty-six patients of the total cohort also received trastuzumab. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated before starting chemotherapy (T0), at 3 months (T3), at 6 (T6), and 12 months (T12). A ≥10% drop of EF, while remaining within the normal range, was reached at T6 in 25.3% of patients from the whole cohort with an early decrease only in FEC/Tax-Group (P = 0.04). A ≥15% GLS reduction was observed in many more (61.6%) patients. GLS decreased early both in the whole population (P < 0.001) and in the subgroups. The FEC-Tax Group showed the worst GLS at T6. Trastuzumab further worsened GLS at T12 (P = 0.031). A significant reduction of GLS was observed in all LV segments and was more relevant in the anterior septum and apex. CONCLUSIONS: The decrease of GLS is more precocious and pronounced in BC patients who received FEC + taxanes. Cardiac function further worsens after 6 months of adjuvant trastuzumab. All LV segments are damaged, with the anterior septum and the apex showing the greatest impairments. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: In breast cancer (BC) patients treated with anthracyclines-based therapies, we aim at assessing whether adjuvant drugs impact cardiac function differently and whether their cardiotoxicity has a regional pattern. METHODS AND RESULTS: In a multicentre study, 146 BC patients (56 ± 11 years) were prospectively enrolled and divided into three groups according to the received treatments: AC/EC-Group (doxorubicin or epirubicin + cyclophosphamide), AC/EC/Tax-Group (AC/EC + taxanes), FEC/Tax-Group (fluorouracil + EC + taxanes). Fifty-six patients of the total cohort also received trastuzumab. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated before starting chemotherapy (T0), at 3 months (T3), at 6 (T6), and 12 months (T12). A ≥10% drop of EF, while remaining within the normal range, was reached at T6 in 25.3% of patients from the whole cohort with an early decrease only in FEC/Tax-Group (P = 0.04). A ≥15% GLS reduction was observed in many more (61.6%) patients. GLS decreased early both in the whole population (P < 0.001) and in the subgroups. The FEC-Tax Group showed the worst GLS at T6. Trastuzumab further worsened GLS at T12 (P = 0.031). A significant reduction of GLS was observed in all LV segments and was more relevant in the anterior septum and apex. CONCLUSIONS: The decrease of GLS is more precocious and pronounced in BC patients who received FEC + taxanes. Cardiac function further worsens after 6 months of adjuvant trastuzumab. All LV segments are damaged, with the anterior septum and the apex showing the greatest impairments. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Reham Selmy Abo El Magd Rasheed; Hatem Mohammed Fathy El Sokkary; Mahmoud Zaki El Amrosy; Mohammed El Sayd El Setiha; Mai Mohammed Abd El Moneim Salama Journal: J Saudi Heart Assoc Date: 2022-07-01