Cardioprotective effect of the low energy extracorporeal shock wave on the doxorubicin-induced cardiomyopathy in breast cancer patients

Abstract

AbstractBackgroundDoxorubicin is a highly effective anti-cancer drug but causes left ventricular (LV) dysfunction, and also induces late-onset cardiomyopathy. Extensive research has been done and is being done to discover preventive treatments. However, an effective and clinically applicable preventive treatment is yet to be discovered. Cardiac Extracorporeal shock waves therapy (C-ESWT) has been suggested to treat inflammatory and ischemic diseases and protect cardiomyocytes from doxorubicin-induced cardiomyopathy. The aim of this study is to assess the safety and efficacy of C-ESWT in treating patients with doxorubicin.MethodsA single-center, randomized, prospective controlled study to evaluate the prevention and safety of doxorubicin-induced cardiomyopathy using C-ESWT was performed. We enrolled 64 breast cancer patients. C-ESWT group 33 patients were treated with our cardiac shock wave therapy (200 shots/spot at 0.09mJ/mm2 for 20 spots, 3 times a week every two-chemotherapy cycles). Efficacy endpoints were LVGLS by 2D speckle tracking echocardiography using Tomtec software and CTRCD. Echocardiography should be performed on the baseline line and every 4 cycles of chemotherapy, followed by a follow-up 3,6 months after chemotherapy to compare the incidence of cardiomyopathy of subclinical LV dysfunction due to chemotherapy between the two groups. CTRCD was defined as a reduction in LV ejection fraction (EF) from a baseline greater than 10% to less than 55% and subclinical CTRCD was defined as a GLS reduction of ≥ 15% compared to the baseline value.ResultsParticipants averaged 50±9 years in age, 100% female. In the results of follow-up 6 months after the end of chemotherapy, there was a significant difference in delta LVGLS between the ESW group and the control group (EF; -0.2±7.7% vs. -3.7±14.2 p-value; 0.076, GLS; -1.2±9.3% vs. -11.2±9.5% p-value; <0.001). In the control group, 2 patients developed CTRCD. A total of 27% (14 patients) of patients developed subclinical LV dysfunction (Control group; 11 vs. ESW group; 3). ESW therapy was performed safely without any serious adverse events.ConclusionIn this prospective study, C-ESWT established efficacy in preventing CRTCD as well as chemotherapy-induced cardiomyopathy using doxorubicin chemotherapy and the safety of C-ESWT use in breast cancer patients.