Use of indicators of systolic and diastolic functions of the left ventricle in the diagnosis of early cardiotoxicity during chemotherapy with doxorubicin: An open, prospective, nonrandomized study

Abstract

BACKGROUND: The search for new markers of early cardiotoxicity (CT) may help reduce the incidence of severe complications in the cardiovascular system during chemotherapy with doxorubicin. AIM: To determine echocardiography (EchoCG) parameters with the potential as CT markers in patients with primary breast cancer (BC) 12 months after the end of chemotherapy with doxorubicin. MATERIAL AND METHODS: An open, prospective, nonrandomized study included 100 patients with verified BC who were treated at the Grodno University Clinic (Grodno, Belarus). Twelve months after the end of chemotherapy, 10 patients were excluded from the general group (7 women refused inclusion, the global longitudinal deformation of the myocardium could not be measured in 3 because of a poor acoustic window). All patients underwent transthoracic echocardiography with the assessment of systolic and diastolic myocardial function before and 12 months after the end of chemotherapy. RESULTS: In 24/90 (26.6%) patients, a relative (before / after 12 months) decrease in global longitudinal myocardial deformity 12% (cardiotoxicity manifestation, CT+ subgroup) was detected. The cutoff point of the absolute decrease in global longitudinal myocardial deformation after 12 months was 18.0% (sensitivity, 87.9%; specificity, 83.7%). Significant differences were found between the absolute values of echocardiography in the CT+ and CT− (without CT manifestations) subgroups 12 months after the end of chemotherapy: the indexed final diastolic volume (FDV) was in 54 (49; 61) CT+ and 61 (53; 65) in CT− (p=0.034), the indexed final systolic volume (FSV) was 17 (15; 20) in CT+ and 20 (17; 23) in CT− (p=0.031), and the ratio of the rates of peaks of early and late filling of the left ventricle (E/A) in was 1.13 (1.10; 1.27) in CT+ and 1.29 (1.15; 1.45) in CT− (p=0.031). The specificity, sensitivity, and cutoff points for these parameters were established. The cutoff, sensitivity, and specificity were 57.7 62.1%, and 66.7% for FDV; 18.8, 60.6%, and 62.5% for FSV; and 1.18, 68.2%, and 66.7% for E/A, respectively. CONCLUSION: The E/A, FDV, and FSV are candidate markers of CT 12 months after the end of chemotherapy with doxorubicin in patients with BC.