Author + information
- Viridiana Perez-Montessoro,
- Itzel Poblano-Aguilar,
- Zuilma Vasquez-Ortiz,
- Jaime Galindo-Uribe and
- Alejandra Armengol-Alonso
Background: Breast cancer (BC) Her2 + patients are exposed to cardiotoxic drugs [Trastuzumab (T) and/or Anthracyclines (A)]. LVEF is not sensitive to detect early cardiac changes related to cardiotoxicity (Ctx). 2D speckle tracking and cardiac biomarkers have shown more sensitivity to detect early Ctx. Adjuvant trial FinHer suggests lower Ctx (0.5%) when Taxanes (T) + (H) are given before (A).
Objectives: To show more sensitivity of the longitudinal strain (GLS) in the echocardiogram (echo) to detect subclinical Ctx compared to the LVEF; to describe if there are any differences in the Ctx related to the chemotherapy (chemo) sequence used.
Methods: In a retrospective cohort of patients with BC from Feb 2008 to Jan 2016, 46 patients were Her2 +, most of them were treated with sequential chemo (A → T + H vs T + H → A), with a cumulative dose of 240 mg/m2 of doxorubicin. An echo was done basal (before chemo), 3, 6, 9, and 12 months after the beginning of chemo to determine the LVEF and GLS. Clinical Ctx was defined as a decrease in the LVEF >10%, to a value below the lower limit of normal. A decline ≥10% in the GLS from baseline was considered abnormal and a marker of subclinical Ctx.
Results: 1 patient (2.1%) presented symptomatic HF (NYHA Class III). During follow up (3, 6, 9 and 12 months), subclinical Ctx was present in 9 patients (19.6%), 9 (19.6%), 11 (23.9%) and 13 (28.3%); the mean (%) LVEF was (66±6.6), (63±9.0), (65±7.0), (65±6.4) and (63±6.9) with a non significant “p” value; and a significant decline in the GLS was observed in 10 patients (21.7%, p=0.012), 13 (28.3%, p=0.034), 15 (32.6%, p=0.95) and 18 (39.1%, p=0.07). Comparing the basal characteristics in Ctx vs the non Ctx group, no significant differences were identified. In the logistic regression analysis the GLS decline (≥10%) basal versus 3 months measurement had OR 7.63 and CI 95% (1.04-55.86) and the A → T + H sequence an OR 7.7 with a CI 95% (1.076-55.43), were kept as independent variables for Ctx.
Conclusions: A decline in GLS is more probable an early marker of Ctx than the LVEF. Early selection may allow to the clinician in prospective studies to offer cardiotoxicity prophylaxis. The order of sequential chemo may impact the development of Ctx.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: ACC International Conferences Best Posters
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1050-454
- 2017 American College of Cardiology Foundation