Early detection of anthracycline induced cardiotoxicity in asymptomatic patients with normal left ventricular systolic function: autonomic versus echocardiographic variables.
OBJECTIVE
To investigate left ventricular dysfunction in patients who had been treated with anthracycline based chemotherapy.


METHODS
Autonomic function was compared with left ventricular diastolic function in 20 asymptomatic women with normal systolic function (left ventricular ejection fraction (LVEF) > 0.50) treated for breast cancer with high dose anthracycline based chemotherapy, and 20 age matched healthy controls. Left ventricular diastolic function was assessed echocardiographically by measuring the early peak flow velocity to atrial peak flow velocity ratio, isovolumic relaxation time, and deceleration time. Heart rate variability analysis was assessed for time domain and frequency domain parameters.


RESULTS
The mean (SD) age of the patients was 45 (7) years and the mean LVEF was 0.59 (0.06). The time interval after the end of chemotherapy was 29 (27) months. One or more diastolic variables were abnormal in 50% of the patients. Heart rate variability was abnormal in 85% of patients. Mean values of both time domain and frequency domain parameters were decreased (p < 0.05), in particular the parasympathetic indices.


CONCLUSIONS
Autonomic impairment occurs in a large proportion of asymptomatic patients with normal systolic left ventricular function after high dose anthracycline based chemotherapy. In particular, heart rate variability analysis may be a sensitive tool to identify the first signs of cardiotoxicity in these patients.
Tjeerdsma
G
G
Department of Cardiology/ Thoraxcenter, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, Netherlands.
Meinardi
M T
MT
van Der Graaf
W T
WT
van Den Berg
M P
MP
Mulder
N H
NH
Crijns
H J
HJ
de Vries
E G
EG
van Veldhuisen
D J
DJ
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D016022:Case-Control Studies; D003971:Diastole; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D015251:Epirubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D008942:Mitoxantrone / Q000009:adverse effects / Q000627:therapeutic use; D012815:Signal Processing, Computer-Assisted; D016277:Ventricular Function, Left / Q000187:drug effects*
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D004317:Doxorubicin; D008942:Mitoxantrone