title: The clinical value of echocardiography and acoustic cardiography to monitor patients undergoing anthracycline chemotherapy.
abstract: BACKGROUND
  Investigate the usefulness of echocardiography and acoustic cardiography to monitor patients exposed to anthracycline chemotherapy.
  
  
  OBJECTIVE
  Serial echocardiographies to monitor systolic function may not be neccessary in all patients undergoing anthracycline chemotherapy.
  
  
  METHODS
  In a prospective study, consecutive patients undergoing anthracycline-containing chemotherapy were evaluated with echocardiography and acoustic cardiography at baseline, after completion of chemotherapy, and after a median follow-up of 3.8 years. Systolic dysfunction was defined as a left ventricular ejection fraction≤50%.
  
  
  RESULTS
  A total of 187 patients (83% female) with a mean age of 55±14 years underwent chemotherapy for breast cancer (73%), malignant lymphoma (23%), and sarcoma (4%). None of the patients had systolic dysfunction at baseline. Patients were treated with doxorubicin 276±74 mg/m2 or epirubicin 317±55 mg/m2. After chemotherapy, 170 (91%) had normal systolic function, 8 (4%) developed systolic dysfunction, and 9 (5%) had died. Of those 8 patients with systolic dysfunction, 4 (50%) improved to normal systolic function, 1 (13%) remained unchanged, and 3 (37%) died. Patients with normal systolic function after chemotherapy had a mortality rate of 3.5%, and 1.8% developed late systolic dysfunction. Acoustic cardiography-derived percent electromechanical activation time>12.4% had a sensitivity of 88% and a specificity of 84% to identify patients with systolic dysfunction (area under the receiver operating characteristic curve 0.87).
  
  
  CONCLUSIONS
  Patients with systolic dysfunction early after anthracycline treatment had worse outcome. Acoustic cardiography was able to identify these patients with a high sensitivity and specificity. Based on the findings of this study, we propose a simple algorithm to monitor patients undergoing anthracycline-containing chemotherapy.
authors.affiliation: Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Odermatt
authors.forename: Andreas
authors.initials: A
authors.lastname: Brauchlin
authors.forename: Thilo
authors.initials: T
authors.lastname: Zander
authors.forename: Andrea
authors.initials: A
authors.lastname: Müller
authors.forename: Michel
authors.initials: M
authors.lastname: Zuber
authors.forename: Ralph
authors.initials: R
authors.lastname: Winterhalder
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D000367:Age Factors; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality; D003324:Coronary Artery Disease / Q000453:epidemiology; D004317:Doxorubicin / Q000009:adverse effects*; D004452:Echocardiography; D015251:Epirubicin / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006347:Heart Sounds; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008223:Lymphoma / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010701:Phonocardiography; D011446:Prospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D004317:Doxorubicin