title: Can comprehensive echocardiographic evaluation provide an advantage to predict anthracycline-induced cardiomyopathy?
abstract: OBJECTIVE
  No definite markers have been established to identify patients in whom anthracycline-containing chemotherapy may represent a high risk for the development of cardiotoxicity. We aimed to evaluate the predictive value of comprehensive echocardiography in anthracycline-induced cardiomyopathy.
  
  
  METHODS
  In a prospective design, the study included 39 patients (9 males, 30 females; mean age 53.7±11.5 years) who received antineoplastic therapy including anthracycline. Comprehensive echocardiographic examination including tissue Doppler imaging and coronary flow reserve was performed before treatment with anthracycline and at the end of a six-month follow-up.
  
  
  RESULTS
  Eight patients (20.5%) developed cardiomyopathy during the follow-up period. Compared to patients with unaffected left ventricular ejection fraction at 6 months, patients with cardiomyopathy exhibited significant differences in baseline left ventricular systolic diameter, mitral E/A, E-wave deceleration time, Sm, Em, Em/Am ratio, Sm-Em duration, and the Tei index. In univariate logistic regression analysis, only Sm (OR 0.40, p=0.002) and the Tei index (OR 3.24, p=0.02) were significant variables for the development of cardiotoxicity. These two were also the only independent predictors of anthracycline cardiotoxicity in multivariate linear regression analysis. Receiver operating characteristic curve analysis yielded a cut-off value of 8 cm/sec for Sm and 0.38 for the Tei index to predict cardiomyopathy.
  
  
  CONCLUSIONS
  Our findings suggest that Sm and myocardial performance index (the Tei index) are significant independent markers to identify patients at high risk for the development of anthracycline-induced cardiomyopathy.
authors.affiliation: Department of Cardiology, Süleyman Demirel University, Isparta, Turkey. aydoganer@yahoo.com
authors.forename: Doğan
authors.initials: D
authors.lastname: Erdoğan
authors.forename: Habil
authors.initials: H
authors.lastname: Yücel
authors.forename: Emine Güçhan
authors.initials: EG
authors.lastname: Alanoğlu
authors.forename: Bayram Ali
authors.initials: BA
authors.lastname: Uysal
authors.forename: Murat
authors.initials: M
authors.lastname: Koçer
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydın
authors.forename: Abdullah
authors.initials: A
authors.lastname: Doğan
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents