Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity.
BACKGROUND
High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity.


METHODS
In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF < 50% and >10 absolute units reduction) and to Group B (LVEF > or = 50%).


RESULTS
Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a > or = 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50%.


CONCLUSIONS
In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.
Civelli
Maurizio
M
Cardiology Unit, European Institute of Oncology, University of Milan, Italy.
Cardinale
Daniela
D
Martinoni
Alessandro
A
Lamantia
Giuseppina
G
Colombo
Nicola
N
Colombo
Alessandro
A
Gandini
Sara
S
Martinelli
Giovanni
G
Fiorentini
Cesare
C
Cipolla
Carlo M
CM
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D002316:Cardiotonic Agents; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000503:physiopathology*; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
D000970:Antineoplastic Agents; D002316:Cardiotonic Agents; D004280:Dobutamine