Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: Effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide

• Published in: International journal of cardiology Vol. 148; no. 2; pp. 194 - 198
• Main Authors: Feola, Mauro, Garrone, Ornella, Occelli, Marcella, Francini, Antonella, Biggi, Alberto, Visconti, Gianluca, Albrile, Fabrizia, Bobbio, Marco, Merlano, Marco
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 14.04.2011; Elsevier
• Subjects: Adjuvants; Adult; Age; Aged; Anthracycline; Anthracyclines - adverse effects; Antibiotics, Antineoplastic - adverse effects; Antimetabolites, Antineoplastic - adverse effects; Antineoplastic Agents, Alkylating - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antracycline cardiotoxicity; Biological and medical sciences; Biomarkers - blood; Brain natriuretic peptide; Breast carcinoma; Breast Neoplasms - drug therapy; Breast Neoplasms - secondary; Breast Neoplasms - surgery; Breast Neoplasms, Male - drug therapy; Breast Neoplasms, Male - secondary; Breast Neoplasms, Male - surgery; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Chemotherapy; Combined Modality Therapy; Cyclophosphamide - adverse effects; Epirubicin - adverse effects; Female; Fluorouracil - adverse effects; Gynecology. Andrology. Obstetrics; Heart; Heart diseases; Heart Failure - chemically induced; Heart Failure - metabolism; Hemoglobin; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Mammary gland diseases; Medical sciences; Middle Aged; Multivariate analysis; Natriuretic Peptide, Brain - blood; Nervous system; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radioisotopes; Radioisotopic ventriculography; Stroke Volume - drug effects; Troponin I; Troponin I - blood; Tumors; Ventricle; Ventricular Dysfunction, Left - chemically induced; Ventricular Dysfunction, Left - metabolism; Brain natriuretic peptide; Chemotherapy; Radioisotopic ventriculography; Antracycline cardiotoxicity; Breast disease; Cardiovascular disease; Breast cancer; Malignant tumor; Left ventricle; Mammary gland diseases; Breast carcinoma; Ventriculography; Treatment; Troponin I; Medical imagery; Ventricular ejection; Hemodynamics; Cardiology; Cancer; Ejection fraction
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2009.09.564

Abstract Anthracyclines are among the most active drugs in breast cancer patients. We planned to evaluate the early and 2-year modification of left ventricular ejection fraction (LVEF) and the effects of chemotherapy on troponin I and neurohormonal assessment. Methods Patients with early breast cancer surgically treated and eligible to adjuvant chemotherapy were enrolled. All patients underwent clinical assessment, radionuclide ventriculography, troponin I and brain natriuretic peptide (BNP) measurements at baseline and one-month (T1), one year (T2) and 2-year (T3) after chemotherapy. Reductions of LVEF ≥ 10% or an overt heart failure were considered cardiovascular events. Results 53 patients, 52 females and 1 male, age 55.3 years were included and followed at T3. A significant reduction of LVEF was observed (from 62 ± 5.5% to 59.3 ± 8.6%, p = 0.04) at T3; BNP increased (from 33.4 ± 41.5 pg/ml to 62.7 ± 94.7 pg/ml, p = 0.005) at T1. Troponin I augmented at T1 (from 0.006 ± 0.01 ng/ml to 0.05 ± 0.04 ng/ml, p = 0.0001) but normalized at T2 (0.005 ± 0.08 ng/ml; p = 0.9). Only baseline BNP was nearly to be significantly correlated with T3 LVEF ( p = 0.07 HR 0.96–1) at multivariate analysis. In 13/53 patients (32.1%) LVEF showed ≥ 10% reduction at T3 (group A); in 40/53 patients (67.9%) LVEF was unchanged (group B). Patients in group A demonstrated higher baseline plasma BNP ( p = 0.02) and lower haemoglobin concentration ( p = 0.007) compared to patients in group B. Conclusions LVEF and BNP modified early after anthracycline chemotherapy and LVEF did not recover at T3. In patients who developed left ventricular systolic dysfunction, a subclinical activation of neurohormonal profile was observed.