Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide.
Anthracyclines are among the most active drugs in breast cancer patients. We planned to evaluate the early and 2-year modification of left ventricular ejection fraction (LVEF) and the effects of chemotherapy on troponin I and neurohormonal assessment.


METHODS
Patients with early breast cancer surgically treated and eligible to adjuvant chemotherapy were enrolled. All patients underwent clinical assessment, radionuclide ventriculography, troponin I and brain natriuretic peptide (BNP) measurements at baseline and one-month (T1), one year (T2) and 2-year (T3) after chemotherapy. Reductions of LVEF ≥ 10% or an overt heart failure were considered cardiovascular events.


RESULTS
53 patients, 52 females and 1 male, age 55.3 years were included and followed at T3. A significant reduction of LVEF was observed (from 62 ± 5.5% to 59.3 ± 8.6%, p=0.04) at T3; BNP increased (from 33.4 ± 41.5 pg/ml to 62.7 ± 94.7 pg/ml, p=0.005) at T1. Troponin I augmented at T1 (from 0.006 ± 0.01 ng/ml to 0.05 ± 0.04 ng/ml, p=0.0001) but normalized at T2 (0.005 ± 0.08 ng/ml; p=0.9). Only baseline BNP was nearly to be significantly correlated with T3 LVEF (p=0.07 HR 0.96-1) at multivariate analysis. In 13/53 patients (32.1%) LVEF showed ≥ 10% reduction at T3 (group A); in 40/53 patients (67.9%) LVEF was unchanged (group B). Patients in group A demonstrated higher baseline plasma BNP (p=0.02) and lower haemoglobin concentration (p=0.007) compared to patients in group B.


CONCLUSIONS
LVEF and BNP modified early after anthracycline chemotherapy and LVEF did not recover at T3. In patients who developed left ventricular systolic dysfunction, a subclinical activation of neurohormonal profile was observed.
Feola
Mauro
M
Cardiovascular Rehabilitation-Heart Failure Unit Ospedale SS Trinita' Fossano, Italy. m_feola@virgilio.it
Garrone
Ornella
O
Occelli
Marcella
M
Francini
Antonella
A
Biggi
Alberto
A
Visconti
Gianluca
G
Albrile
Fabrizia
F
Bobbio
Marco
M
Merlano
Marco
M
D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects; D015251:Epirubicin / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006333:Heart Failure / Q000139:chemically induced / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects*; D019210:Troponin I / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000378:metabolism
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil