title: Early cardiac function monitoring for detection of subclinical Doxorubicin cardiotoxicity in young adult patients with breast cancer.
abstract: OBJECTIVE
  As doxorubicin cardiotoxicity is considered irreversible, early detection of cardiotoxicity and prevention of overt heart failure is essential. Although there are monitoring guidelines for cardiotoxicity, optimal timing for early detection of subclinical doxorubicin cardiotoxicity is still obscure. The purpose of this study is to determine optimal timing of cardiac monitoring and risk factors for early detection of doxorubicin cardiotoxicity in young adult patients with breast cancer.
  
  
  METHODS
  Medical records of 1,013 breast cancer patients diagnosed from January 2009 to December 2010 is being reviewed and analyzed. Properly monitored patients are defined as patients who underwent transthoracic echocardiography before and after the chemotherapy. The definition of subclinical cardiotoxicity (SC) either decreases left ventricular ejection fraction (LVEF) more than 10% or the LVEF declines under 55% from baseline without heart failure symptoms.
  
  
  RESULTS
  Twenty-nine out of 174 (16.7%) properly monitored young adult female patients (mean age, 52±10 years old) developed SC. The mean interval of cardiac evaluation of SC group was 5.5±3.0 months. Among the risk factors, the history of coronary artery disease, cumulative dose of doxorubicin ≥300 mg/m(2) and use of trastuzumab after doxorubicin therapy were associated with development of SC. At cumulative dose of doxorubicin 244.5 mg/m(2), SC can be predicted (sensitivity, 71.4%; specificity, 70.9%; area under the curve, 0.741; 95% confidence interval, 0.608-0.874; p=0.001).
  
  
  CONCLUSIONS
  In young adult patients with breast cancer, SC was common at cumulative dose of doxorubicin <300 mg/m(2) and early performance of cardiac monitoring before reaching the conventional critical dose of doxorubicin might be a proper strategy for early detection of SC.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Woo-Baek
authors.initials: WB
authors.lastname: Chung
authors.forename: Jeong-Eun
authors.initials: JE
authors.lastname: Yi
authors.forename: Jung Yeon
authors.initials: JY
authors.lastname: Jin
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Choi
authors.forename: Chan Seok
authors.initials: CS
authors.lastname: Park
authors.forename: Woo-Chan
authors.initials: WC
authors.lastname: Park
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
keywords: Breast neoplasms; Cardiac monitoring; Cardiotoxicity; Doxorubicin; Trastuzumab