Among patients being treated for breast cancer, lymphoma or gastric cancer with anthracycline-based chemotherapy, cardiotoxicity from the treatment was most pronounced in those with CV risk factors, especially diabetes, according to new data.
The researchers conducted a prospective study of 83 patients (54 with breast cancer, 20 with lymphoma, nine with gastric cancer; mean age, 52 years; 78% women) undergoing chemotherapy with anthracyclines.
All patients underwent echocardiography before treatment, after the first cycle, after the third cycle and 1 week after treatment for assessment of dimensions, systolic and diastolic function of the left and right ventricles and LV strain.
Patients were stratified by CV risk factors, including hypertension, diabetes, dyslipidemia and smoking. Echocardiographic data were compared by CV risk factor and by cancer type.
The results were presented by Ana Catarina Gomes, MD, cardiologist in training at Hospital Garcia de Orta in Almada, Portugal, at EuroEcho-Imaging 2016.
In the cohort, 31.3% had hypertension, 7.2% had diabetes, 15.7% had dyslipidemia and 15.7% were smokers.
Gomes and colleagues found the cohort had significant reductions in global longitudinal strain (from –20.4% to –17.3%; P < .0005) and LV ejection fraction (from 65% to 60.2%; P < .0005) during therapy.
They also observed a trend toward greater reduction in LVEF among patients with hypertension (hypertension, 7.5%; no hypertension, 4.3%; P = .067).
According to the researchers, patients with diabetes had worse global longitudinal strain than those without diabetes after the first cycle (–17.3% vs. –20.1%; P = .014) and after the third cycle (–17.2% vs. –19.5%; P = .023) despite having similar values at baseline (P = .127).
“Subclinical reduction in global longitudinal strain is an early predictor of [HF] and was particularly pronounced in patients with diabetes,” Gomes said in a press release.
After the first cycle, LVEF decreased less in patients with breast cancer than in those with other cancers (P = .011 for absolute and relative values), and E’ lateral was higher in patients with breast cancer compared with other cancers (P < .0005 at baseline, after first cycle and after third cycle; P = .023 1 week after treatment), Gomes and colleagues found.
Segmental longitudinal strain showed better deformation in those with breast cancer vs. other cancers after the third cycle, including at the basal segments of the inferior wall and inferior septum and at the mid segments of the posterior wall and anterior septum (P < .02 for all), according to the researchers.
Cumulative dose of anthracycline therapy did not affect the results, they found.
“We hypothesize that cancers themselves could have direct cardiotoxic effects induced by cytokines,” Gomes said in the release. “These cardiotoxic effects may vary with the type of cancer. Cancer patients should strictly control [CV] risk factors with lifestyle changes and, if necessary, with medication. But of course [CV] prevention should never postpone the beginning of chemotherapy since treating the cancer is the first priority.” – by Erik Swain
Gomes AC, et al. Abstract P1265. Presented at: EuroEcho-Imaging; Dec. 7-10, 2016; Leipzig, Germany.
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