title: Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease.
abstract: OBJECTIVE
  The goal of this study was to determine if low to moderate doses of anthracycline-based chemotherapy (Anth-bC) are associated with subclinical cardiovascular (CV) injury.
  
  
  BACKGROUND
  Cancer survivors who receive Anth-bC experience premature CV events. It is unknown whether low to moderate doses of anthracyclines promote early subclinical CV disease manifested by deteriorations in left ventricular ejection fraction (LVEF) or increases in aortic stiffness, or if these doses are associated with changes in quality of life (QOL).
  
  
  METHODS
  In 53 men and women with breast cancer, leukemia, or lymphoma, we assessed left ventricular volumes, LVEF, circumferential strain, aortic pulse wave velocity, late gadolinium enhancement, serum B-type natriuretic peptide, troponin I, and the impact of treatment on QOL before and 1, 3, and 6 months after receipt of Anth-bC.
  
  
  RESULTS
  Participants averaged 50 ± 2 (range 19 to 80) years in age, 58% were women, 17% were black, and they each received a range of 50 to 375 mg/m(2) of doxorubicin-equivalent chemotherapy. Left ventricular end-systolic volume (48 ± 3 ml to 54 ± 3 ml; p = 0.02), left ventricular strain (-17.7 ± 0.4 to -15.1 ± 0.4; p = 0.0003), pulse wave velocity (6.7 ± 0.5 m/s to 10.1 ± 1 m/s; p = 0.0006), and QOL deterioration (15.4 ± 3.3 to 28.5 ± 3.9; p = 0.008) increased, whereas LVEF (58 ± 1% to 53 ± 1%; p = 0.0002) decreased within 6 months after low to moderate doses of Anth-bC. All findings persisted after accounting for age, gender, race (white/black), doxorubicin-equivalent dose, doxorubicin administration technique, comorbidities associated with CV events, and cancer diagnosis (p = 0.02 to 0.0001 for all). There were no new late gadolinium enhancement findings after 6 months.
  
  
  CONCLUSIONS
  In these study patients, low to moderate doses of Anth-bC were associated with the early development of subclinical abnormalities of cardiac and vascular function that in other populations are associated with the future occurrence of CV events.
authors: Department of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
authors: Brandon C
authors: BC
authors: Drafts
authors: Katie M
authors: KM
authors: Twomley
authors: Ralph
authors: R
authors: D'Agostino
authors: Julia
authors: J
authors: Lawrence
authors: Nancy
authors: N
authors: Avis
authors: Leslie R
authors: LR
authors: Ellis
authors: Vinay
authors: V
authors: Thohan
authors: Jennifer
authors: J
authors: Jordan
authors: Susan A
authors: SA
authors: Melin
authors: Frank M
authors: FM
authors: Torti
authors: William C
authors: WC
authors: Little
authors: Craig A
authors: CA
authors: Hamilton
authors: W Gregory
authors: WG
authors: Hundley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy*; D008223:Lymphoma / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D011788:Quality of Life; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D059289:Vascular Stiffness / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain
keywords: Anth-bC; B-type natriuretic peptide; BNP; CMR; CV; LVEDV; LVEF; LVESV; MLHFQ; Minnesota Living with Heart Failure Questionnaire; PWV; QOL; TE; TR; TnI; anthracycline-based chemotherapy; cardiac magnetic resonance; cardio-oncology; cardiotoxicity; cardiovascular; chemotherapy; echo time; left ventricular ejection fraction; left ventricular end-diastolic volume; left ventricular end-systolic volume; pulse wave velocity; quality of life; repetition time; troponin I
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