Abstract 1506P
Background
Although epirubicin-based regimens are highly effective in breast cancer care, their cardiotoxicity may be limiting for their prescriptions. The use of left ventricular ejection fraction (LVEF) for screening of epirubicin-induced cardiotoxicity (EIC) may be too late to allow intervention and preventive measures. The aim of our study was to investigate the predictive value of 2D- Global Longitudinal Strain (GLS) to early detect EIC.
Methods
We conducted a prospective study from March 2018 to March 2020 on breast cancer patients who received epirubicin-based regimens without further Trastuzumab. We measured their LVEF and GLS before chemotherapy, at three months (T3) and at 12 months (T12) from the last epirubicin infusion. EIC was defined as a decrease of 10% in LVEF to a value below 53% according to ASE and EACI 2014 expert consensus.
Results
We enrolled 66 patients with a mean age at diagnosis of 47 ±9 years old. At baseline, median LVEF was 70% and median GLS was -21%. Epirubcin median dose was 600mg/m2 [300-900] in metatstatic patients and 300mg/m2 [200-600] in the adjuvant setting. At T3, median LVEF was 65%, median GLS was -19% and median GLS decrease was 5% with only two patients presenting EIC. However, in patients who presented cardiotoxicity at the T12 examination (n=3), median GLS at T3 was -16% and median GLS decrease was 19% (p=0.002 and p<0.001 respectively when compared to patients who did not develop EIC at T12). GLS decrease at T3 was an independent predictor of the onset of EIC at T12. ROC-curve analysis indicated that GLS decline at T3 had an AUC of 0.95 (95% CI of 0.88 -1) for predicting EIC at T12. The cut-off value was 9% (Sensitivity=100%; Specificity=88%). Age and left-sided thoracic irradiation did not increase the risk of EIC in our study while the cumulative dose of epirubicin significantly affected the cardiologic findings (p=0.001).
Conclusions
Systolic GLS of the left ventricle was found to be an accurate tool for the detection of subclinical myocardial dysfunction before LVEF declines, thus allowing to start cardioprotective treatment before heart failure occurs. Further larger multicentric studies evaluating the best cardioprotective molecules to be initiated in these patients should be conducted to elaborate new and common guidelines.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.