Author + information
- Thiago Quinaglia Silva,
- Ferreira de Souza Thiago,
- Felipe Osorio Costa,
- Tom Neilan,
- Ravi Shah,
- Velloso Licio,
- Wilson Nadruz Junior,
- Fabricio Brenelli,
- Sposito Andrei Carvalho,
- Otavio Coelho,
- Michael Jerosch-Herold,
- Otavio Rizzi and
- Coelho Filho
Background: Doxorubicin (DOX) persists as a key component of chemotherapy regimens in adult malignancies, though cardiovascular disease remains a leading cause of morbidity and mortality among these patients. Experimental studies indicate interstitial myocardial fibrosis and decreased myocyte size constitute a common tissue phenotype. We aimed to characterize DOX-associated remodeling by Cardiac Magnetic Resonance (CMR) extracellular volume (ECV) and intracellular lifetime of water (tau) in breast cancer patients.
Methods: Twenty-seven breast cancer women (mean-age 52±9years, BMI 27±4kg/m2), without heart failure, underwent CMR imaging (3T-Achieva, Philips) before and 3 times (t) serially (median days after DOX: t-1: 70, t-2: 154, t-3: 364) after 4-cycles of adjuvant DOX (60mg/m2). CMR assessed left ventricular (LV) ejection fraction (EF), T1 mapping pre and post gadolinium and late gadolinium enhancement imaging. Biomarkers were obtained before and 72 hours after each DOX-cycle.
Results: Patients had normal baseline LVEF (69±4%), LV Mass-index (51±9g/m2) and absence of late gadolinium enhancement. After DOX, LVEF (t-1:60±7, t-2:56±4 and t-3:54±7%) and LV Mass-index (t-1:44±5, t-2:42±4, t-3:38±7g/m2) significantly decreased (all p < 0.01). DOX-therapy was associated with progressive expansion of ECV (baseline: 0.32±0.07, t-1:0.33±0.05, t-2:0.35±0.05, t-3:0.36±0.04), reduction of tau (baseline: 0.17±0.02, t-1:0.14±0.05, t-2:0.13±0.05, t-3:0.13±0.08, all p < 0.05). Likewise, time after DOX positively associated with ECV (r=0.5, p < 0.01) and negatively with tau (r=-0.6, p<0.01). LVEF had a positive association with tau (p<0.05). LV Mass-index positively related with tau and a negatively with ECV (p< 0.05), indicating loss of LV Mass due to fibrosis and cardiomyocyte size adjustment. Ultra-sensitive troponin after each DOX-cycle positively associated with time after DOX (p<0.001).
Conclusions: DOX-therapy was associated with a significant decline in both LVEF and LV Mass driven by both a reduction in cardiomyocyte size (atrophy) and an expansion of the extra-cellular volume (diffuse replacement fibrosis), despite the absence of late gadolinium enhancement.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: MR Scar and Perfusion
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1244-197
- 2017 American College of Cardiology Foundation