title: Effects of Paclitaxel and Carboplatin combination on mechanical myocardial and microvascular functions: a transthoracic Doppler echocardiography and two-dimensional strain imaging study.
abstract: OBJECTIVE
  Paclitaxel and carboplatin are frequently used chemotherapy drugs in the treatment of gynecologic malignancies. Little is known about their effects on left ventricular mechanical and coronary microvascular functions.
  
  
  METHODS
  Thirty consecutive patients were prospectively enrolled. Patients underwent transthoracic echocardiography (TTE) before and after chemotherapy, to evaluate left ventricular mechanical functions and coronary flow reserve (CFR). A comprehensive TTE, tissue Doppler and two-dimensional (2D) strain imaging were performed and coronary flow velocity was measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. Mitral annular velocities by tissue Doppler, peak strain, and systolic strain rate by velocity vector imaging (VVI) were measured. Baseline measurements were compared with healthy controls (n = 26).
  
  
  RESULTS
  No patient developed heart failure (HF) symptoms, no significant change occurred in left ventricular ejection fraction or cardiac output and no significant difference was observed in CFR after chemotherapy. Baseline mean longitudinal peak strain and systolic stain rate were similar between patients and controls: -17.5 ± 2.6% versus -17.6 ± 2.2% (P = NS) and -1.04 ± 0.14/sec versus -1.05 ± 0.12/sec (P = NS). Peak strain and systolic strain rate decreased significantly after chemotherapy (from -17.5 ± 2.6% to -16.2 ± 2.5%, P < 0.02; and from -1.05 ± 0.12/sec to -0.96 ± 0.11/sec, P = 0.01, respectively). However, mean longitudinal velocity did not change significantly.
  
  
  CONCLUSIONS
  Paclitaxel and carboplatin combination did not impair CFR; however, this chemotherapy combination could induce subtle impairment in myocardial mechanical function which can be detected by advanced deformation imaging techniques rather than by tissue Doppler imaging or conventional 2D and Doppler echocardiography.
authors.affiliation: Department of Cardiology, The University of Baskent, Ankara, Turkey.
authors.forename: Cihan
authors.initials: C
authors.lastname: Altin
authors.forename: Leyla Elif
authors.initials: LE
authors.lastname: Sade
authors.forename: Saadet
authors.initials: S
authors.lastname: Demirtas
authors.forename: Emir
authors.initials: E
authors.lastname: Karacaglar
authors.forename: Suleyman
authors.initials: S
authors.lastname: Kanyilmaz
authors.forename: Vahide
authors.initials: V
authors.lastname: Simsek
authors.forename: Ali
authors.initials: A
authors.lastname: Ayhan
authors.forename: Haldun
authors.initials: H
authors.lastname: Muderrisoglu
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology; D001783:Blood Flow Velocity / Q000187:drug effects; D016190:Carboplatin / Q000494:pharmacology*; D003326:Coronary Circulation / Q000187:drug effects; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000187:drug effects; D008875:Middle Aged; D017239:Paclitaxel / Q000494:pharmacology*; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel
keywords: cardiac toxicity; coronary flow reserve; strain-strain rate