title: Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy.
abstract: OBJECTIVE
  Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling.
  
  
  METHODS
  Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months).
  
  
  RESULTS
  At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA) >1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P<0.05).
  
  
  CONCLUSIONS
  Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.
authors: Division of Heart Failure and Cardiac Rehabilitation, Cardiovascular Department, Catholic University of the Sacred Heart Rome, Italy.
authors: M
authors: M
authors: Lotrionte
authors: G
authors: G
authors: Palazzoni
authors: R
authors: R
authors: Natali
authors: G
authors: G
authors: Comerci
authors: A
authors: A
authors: Abbate
authors: F
authors: F
authors: Loperfido
authors: G
authors: G
authors: Biondi-Zoccai
mesh_terms: D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging; D003627:Data Interpretation, Statistical; D003971:Diastole; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
chemical_list: D018943:Anthracyclines