Systolic versus diastolic cardiac function variables during epirubicin treatment for breast cancer.
Anthracyclines are important in the treatment of numerous malignant diseases but the use is limited by a risk of heart failure (CHF). LVEF (left ventricular ejection fraction) measurements by radionuclide ventriculography with multiple gated acquisition (MUGA) is often used for cardiac monitoring. However, diastolic variables have been proposed as sensitive supplements. It was hypothesized that a change in diastolic filling variables measured by MUGA could identify individuals after epirubicin treatment (ET) in risk of developing heart failure. A retrospective analysis of registered raw data. Individuals completing high-dose ET for breast cancer were selected from a 2-year period. All had MUGA-scans performed prior to and after ET and were observed clinically for late development of CHF. Eleven of 34 individuals developed CHF. A significant LVEF-reduction was recorded after ET with only minor changes in diastolic parameters. Development of CHF was related to dose, entry-blood pressure and inversely to post-epirubicin LVEF. Risk of CHF was high if LVEF <50% (Hazard ratio 3.31). Epirubicin induces considerable decrease in LVEF and a high risk of CHF. The risk of CHF is significantly higher if LVEF is reduced after ET. Diastolic MUGA-variables seem to add little information to conventional measurements of LVEF.
Appel
Jon M
JM
Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark. jomiap02@heh.regionh.dk
Jensen
Benny V
BV
Nielsen
Dorte L
DL
Ryberg
Marianne
M
Zerahn
Bo
B
D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001794:Blood Pressure; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000556:secondary; D016009:Chi-Square Distribution; D003971:Diastole; D004305:Dose-Response Relationship, Drug; D015251:Epirubicin / Q000009:adverse effects*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006333:Heart Failure / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects*
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin