Myocardial function in patients with breast cancer after therapy with anthracyclines and chest irradiation.
OBJECTIVE
To evaluate and compare the left ventricular performance in female patients with breast cancer treated with chemotherapy (CT) and either left or right thoracic irradiation (RT), using Doppler echocardiography.


METHODS
Thirty-four patients with cancer of the left breast treated with surgical resection, adjuvant EC CT (epirubicin and cyclophosphamide) and conventionally fractionated left thoracic RT (study group) and a gender-and age-matched group of 34 patients with cancer of the right breast also treated with surgical resection, adjuvant EC CT and right thoracic RT (control group), were studied by echocardiography. Assessed were the left ventricular systolic performance by measuring the global ejection fraction (EF) and the shortening fraction (SF). Left ventricular diastolic performance was assessed by measuring the Doppler transmitral flow: the maximal velocity of the E wave (rapid filling/ Emax) and A wave (atrial filling/Emax) were measured. The ratio of Emax/Amax, the pressure half-time (PHT) of the E wave and the isovolumic relaxation time (IVRT) were also calculated.


RESULTS
The left ventricular diastolic performance was altered in the study group which showed a significant decrease (p <0.001) of Emax. A wave was significantly increased in the study group compared with the control group (p <0.001. The mitral E/A ratio was subunitary in both groups but more depressed in the study group. The E wave PHT was more prolonged in the study group compared to the control group (p <0.001). The IVRT was prolonged in the study group compared with the controls (p <0.05). The left ventricular systolic performance was within normal limits in both groups.


CONCLUSIONS
Our Doppler echocardiography study documented an impaired left ventricular diastolic performance in patients with cancer of the left breast treated with fractionated thoracic RT and CT. This impairment is due to poor left ventricular compliance.
Radulescu
D
D
Department of Cardiology, 5th Medical Hospital, University of Medicine Cluj, Cluj, Romania. dan_rad31@yahoo.com
Pripon
S
S
Parv
A
A
Duncea
C
C
Ciuleanu
T E
TE
Radulescu
L I
LI
D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D003971:Diastole / Q000187:drug effects; D015150:Echocardiography, Doppler; D015251:Epirubicin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D009206:Myocardium; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging*
D018943:Anthracyclines; D000970:Antineoplastic Agents; D015251:Epirubicin; D003520:Cyclophosphamide