Combined NT-pro-BNP and CW-Doppler ultrasound cardiac output monitoring (USCOM) in epirubicin and liposomal doxorubicin therapy.
BACKGROUND
Chemotherapy with epirubicin is approved in women with breast cancer and is associated with a certain degree of cardiotoxicity.


OBJECTIVE
Epirubicin changes stroke volume, cardiac output and systemic vascular resistance, while liposomal doxorubicin does not.


METHODS
75 patients with HER-2-positive metastatic breast cancer were continuously measured with CW-Doppler ultrasound for stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) before, during and after drug infusion in combination with NT-pro-BNP before and 10 min after drug infusion.


RESULTS
Epirubicin infusion increased stroke volume significantly in low-level NT-pro-BNP (62+/-23 ml vs. 74+/-29 ml, p=0.004) and high-level NT-pro-BNP (48+/-5 ml vs. 64+/-20 ml, p=0.131), while liposomal doxorubicin infusion increased stroke volume significantly in low-level NT-pro-BNP (54+/-16 ml vs. 67+/-22 ml, p=0.001) and high-level NT-pro-BNP (65+/-22 ml vs. 82+/-27 ml, p=0.001). Cardiac output was significantly increased in epirubicin (p=0.004) by 20% (NT-pro-BNP<125 pg/ml) and not significantly 38% (NT-pro-BNP>125 pg/ml; p=0.144), while in liposomal doxorubicin cardiac output was significantly increased by 23% (NT-pro-BNP<125 pg/ml; p=0.023) and 33% (NT-pro-BNP>125 pg/ml; p=0.001). In liposomal doxorubicin cardiac index was significantly increased by 26% (NT-pro-BNP<125 pg/ml; p=0.021) and 33% (NT-pro-BNP>125 pg/ml; p=0.0001). SVR was significantly reduced during and after epirubicin therapy.


CONCLUSIONS
Using the CW-Doppler USCOM a different hemodynamic response to epirubicin vs. liposomal doxorubicin is evident. Epirubicin leads to a significant upregulation of stroke volume and cardiac output, which is even more pronounced in the high-level NT-pro-BNP group, while liposomal doxorubicin does not change immediate hemodynamics. No deterioration of cardiac function using the real-time CW-Doppler ultrasound USCOM or an increase in NT-pro-BNP levels was evident during epirubicin or liposomal doxorubicin therapy.
Knobloch
K
K
Plastic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany. kknobi@yahoo.com
Tepe
J
J
Rossner
D
D
Lichtinghagen
R
R
Luck
H J
HJ
Busch
K H
KH
Vogt
P M
PM
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy; D002302:Cardiac Output / Q000187:drug effects* / Q000502:physiology; D004317:Doxorubicin / Q000008:administration & dosage*; D016903:Drug Monitoring / Q000379:methods*; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D010446:Peptide Fragments / Q000008:administration & dosage*; D018608:Ultrasonography, Doppler / Q000379:methods*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D015251:Epirubicin; D004317:Doxorubicin