title: Cardiac sympathetic hyperactivity after chemotherapy: early sign of cardiotoxicity?
abstract: BACKGROUND
  Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 (123I-mIBG) seems to precede the drop in left ventricular ejection fraction.
  
  
  OBJECTIVE
  To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline.
  
  
  METHODS
  Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of 123I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2).
  
  
  RESULTS
  Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of 123I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of 123I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of 123I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of 123I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02).
  
  
  CONCLUSIONS
  In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with 123I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity.
authors.affiliation: Pós-Graduação em Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, BR.
authors.forename: Sarita Lígia Pessoa de Melo Machado
authors.initials: SL
authors.lastname: Guimarães
authors.affiliation: Pós-Graduação em Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, BR.
authors.forename: Simone Cristina Soares
authors.initials: SC
authors.lastname: Brandão
authors.affiliation: Hospital Santa Joana, Recife, PE, BR.
authors.forename: Luciana Raposo
authors.initials: LR
authors.lastname: Andrade
authors.affiliation: Pós-Graduação em Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, BR.
authors.forename: Rafael José Coelho
authors.initials: RJ
authors.lastname: Maia
authors.affiliation: Pós-Graduação em Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, BR.
authors.forename: Brivaldo
authors.initials: B
authors.lastname: Markman Filho
mesh_terms: D019797:3-Iodobenzylguanidine; D000328:Adult; D000367:Age Factors; D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D066126:Cardiotoxicity / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects*; D006331:Heart Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000187:drug effects; D013564:Sympathetic Nervous System / Q000187:drug effects; D000068878:Trastuzumab / Q000009:adverse effects*
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D000068878:Trastuzumab