title: Diastolic Dysfunction Following Anthracycline-Based Chemotherapy in Breast Cancer Patients: Incidence and Predictors.
abstract: BACKGROUND
  Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data from longitudinal studies of diastolic dysfunction (DD) in this group of patients are scarce. The objective of the present study was to assess the incidence, evolution, and predictors of DD in patients with breast cancer treated with anthracyclines.
  
  
  METHODS
  This analytical, observational cohort study comprised 100 consecutive patients receiving anthracycline-based chemotherapy (CHT) for breast cancer. All patients underwent clinical evaluation, echocardiogram, and measurement of cardiac biomarkers at baseline, end of anthracycline-based CHT, and at 3 months and 9 months after anthracycline-based CHT was completed. Fifteen patients receiving trastuzumab were followed with two additional visits at 6 and 12 months after the last dose of anthracycline-based CHT. A multivariate analysis was performed to find variables related to the development of DD. Fifteen of the 100 patients had baseline DD and were excluded from this analysis.
  
  
  RESULTS
  At the end of follow-up (median: 12 months, interquartile range: 11.1-12.8), 49 patients (57.6%) developed DD. DD was persistent in 36 (73%) but reversible in the remaining 13 patients (27%). Four patients developed cardiotoxicity (three patients had left ventricular systolic dysfunction and one suffered a sudden cardiac death). None of the patients with normal diastolic function developed systolic dysfunction during follow-up. In the logistic regression model, body mass index (BMI) and age were independently related to the development of DD, with the following odds ratio values: BMI: 1.19 (95% confidence interval [CI]: 1.04-1.36), and age: 1.12 (95% CI: 1.03-1.19). Neither cardiac biomarkers nor remaining clinical variables were predictors of DD.
  
  
  CONCLUSIONS
  Development of diastolic dysfunction after treatment with anthracycline or anthracycline- plus trastuzumab chemotherapy is common. BMI and age were independently associated with DD following anthracycline chemotherapy.
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain josemaria.serrano@salud.madrid.org.
authors.forename: José M
authors.initials: JM
authors.lastname: Serrano
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Iria
authors.initials: I
authors.lastname: González
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Del Castillo
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Morales
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Moreno
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Jiménez
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cristóbal
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Catherine
authors.initials: C
authors.lastname: Graupner
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Talavera
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Curcio
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Martínez
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Guerra
authors.affiliation: Hospital Universitario de Fuenlabrada, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain; Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Joaquín J
authors.initials: JJ
authors.lastname: Alonso
mesh_terms: D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D018943:Anthracyclines
keywords: Anthracycline chemotherapy; Breast cancer; Cardiac biomarkers; Diastolic dysfunction