title: Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer.
abstract: Long-term cardiovascular morbidity is increasingly observed in chemotherapy-treated testicular cancer survivors, but little is known of early sub-clinical changes in cardiac function. We prospectively evaluated cardiac function in testicular cancer patients by echocardiography. Systolic (Wall Motion Score Index) and diastolic (E/A-ratio and Tissue Velocity Imaging (TVI)) parameters, and serum levels of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) were assessed before the start of chemotherapy and 1 year later. Echocardiography data were compared with an age-matched group of healthy controls. Forty-two patients treated with bleomycin, etoposide and cisplatin were evaluated (median age 27 years, range 18-50). Systolic function and E/A-ratio did not change, whereas the median TVI decreased (12.0 vs 10.0 cms(-1); P=0.002). Median levels of NT-proBNP increased (5 vs 18 pmoll(-1), P=0.034). Compared with controls, TVI before the start of chemotherapy was not significantly different. In conclusion, we found that at a median of 10 months after cisplatin-based treatment for testicular cancer, TVI decreased significantly, indicating a deterioration of diastolic cardiac function. Serum levels of NT-proBNP increased. The prognostic significance of these changes for future cardiovascular morbidity is not clear.
authors.affiliation: Department of Medical Oncology, University Medical Center Groningen and University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Altena
authors.forename: E C
authors.initials: EC
authors.lastname: de Haas
authors.forename: J
authors.initials: J
authors.lastname: Nuver
authors.forename: C A J
authors.initials: CA
authors.lastname: Brouwer
authors.forename: M P
authors.initials: MP
authors.lastname: van den Berg
authors.forename: A J
authors.initials: AJ
authors.lastname: Smit
authors.forename: A
authors.initials: A
authors.lastname: Postma
authors.forename: D Th
authors.initials: DT
authors.lastname: Sleijfer
authors.forename: J A
authors.initials: JA
authors.lastname: Gietema
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D004452:Echocardiography; D005047:Etoposide / Q000008:administration & dosage; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009919:Orchiectomy; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D001761:Bleomycin; D020097:Natriuretic Peptide, Brain; D005047:Etoposide; D002945:Cisplatin