title: Temporal changes in standard and tissue Doppler imaging echocardiographic parameters after anthracycline chemotherapy in women with breast cancer.
abstract: Anthracyclines are established cardiotoxic agents; however, the exact extent and time course of such cardiotoxicity has not been appraised in detail. We aimed to exploit serial measurements of standard and tissue Doppler imaging (TDI) echocardiographic parameters collected in a prospective clinical trial to clarify the outlook of cardiac function during and long after anthracycline chemotherapy. Women enrolled in a randomized trial focusing on liposomal doxorubicin-based chemotherapy for breast cancer and providing ≥4 separate echocardiographic assessments were included. Repeat-measure nonparametric analyses were used to appraise changes over time in the standard and tissue Doppler imaging echocardiographic parameters. A total of 39 patients with serial imaging evaluations were enrolled. Significant temporal changes were found for the left ventricular ejection fraction and diastolic parameters, despite different temporal trends. Specifically, the left ventricular ejection fraction exhibited a V-shaped trend, decreasing initially from 63% to 61% but then recovering to 64% (p <0.001), with a similar trend in the TDI E/Em ratio (p = 0.011). In contrast, persistent impairments typical of an L-shaped trend were found for the E wave (p = 0.006), TDI lateral Em wave (p = 0.001), and TDI septal Em wave (p = 0.001). In conclusion, subclinical temporal changes in the standard and TDI echocardiographic parameters after anthracycline chemotherapy showed a distinctive pattern of transient impairment followed by full recovery of the left ventricular ejection fraction versus a persistent impairment of the diastolic parameters, which must be taken into account in the everyday treatment of such patients.
authors.affiliation: Division of Heart Failure and Cardiac Rehabilitation, Complesso Integrato Columbus, Rome, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Lotrionte
authors.forename: Elena
authors.initials: E
authors.lastname: Cavarretta
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Eleonora
authors.initials: E
authors.lastname: Mezzaroma
authors.forename: Eugenia
authors.initials: E
authors.lastname: De Marco
authors.forename: Silvia
authors.initials: S
authors.lastname: Di Persio
authors.forename: Francesco
authors.initials: F
authors.lastname: Loperfido
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palazzoni
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D015150:Echocardiography, Doppler; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006331:Heart Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume; D043823:Taxoids / Q000008:administration & dosage; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil