title: Can the epirubicin cardiotoxicity in cancer patients be prevented by angiotensin converting enzyme inhibitors?
abstract: OBJECTIVE
  The aim of this study was to assess whether treatment with angiotensin converting enzyme inhibitors (ACEI) can prevent the alteration of left ventricular systolic and diastolic performance in cancer patients treated with different chemotherapy regimens containing epirubicin.
  
  
  METHODS
  In this prospective study , 68 patients with different malignant tumors treated with epirubicin and perindopril in different chemotherapy protocols (study group), and a gender- and age-matched group of 68 patients with different malignant tumors treated with epirubicin without perindopril in different chemotherapy protocols (control group), were assessed by Doppler echocardiography. Left ventricular systolic function was assessed by measuring left ventricular ejection fraction (EF). Left ventricular diastolic function was assessed by Doppler ultrasound by evaluating the transmitral flow. We also assessed the QTc on the 12 lead electrocardiograms.
  
  
  RESULTS
  At the end of chemotherapy the left ventricular systolic function was less altered in the study group compared to the control group and was superior in the study group (epirubicin+ACEI) compared to the control group (epirubicin alone). We documented a significantly deteriorated left ventricular diastolic function in both groups at the completion of chemotherapy. QTc time in both arms was also significantly prolonged.
  
  
  CONCLUSIONS
  In the present echo-Doppler study we documented a preserved left ventricular systolic performance in patients with various malignancies treated with epirubicin plus perindopril. Although co-treatment with ACEI prevented the alteration of systolic performance, it failed to prevent the deterioration of the left ventricular diastolic performance impairment due to poor left ventricular compliance.
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu", 5th Medical Hospital, Department of Cardiology, Cluj-Napoca, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Radulescu
authors.forename: E
authors.initials: E
authors.lastname: Buzdugan
authors.forename: T E
authors.initials: TE
authors.lastname: Ciuleanu
authors.forename: N
authors.initials: N
authors.lastname: Todor
authors.forename: L
authors.initials: L
authors.lastname: Stoicescu
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D003971:Diastole; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D015251:Epirubicin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D020913:Perindopril