Abstract 213P
Background
Although epirubicin has improved outcome in breast cancer (BC) patients, it is associated to myocardial dysfunction affecting patients’ quality of life. The use of 2D-speckle-tracking echocardiography allows early myocardial dusfunction detection. The aim of this study was to evaluate early changes in Global Longitudinal Strain (GLS) and their association with later cardiotoxicity.
Methods
77 BC patients without cardiovascular risk factors were prospectively included. All patients received epirubicin. Twenty-five patients received further trastuzumab. left ventricular ejection fraction (LVEF) and GLS we measured before initiation of epirubicin, at 3 months and one year after chemotherapy (CT). CT related cardiac dysfunction (CRCD) was defined as a LVEF decrease of 10% or a value below 53%.
Results
Mean age was 45 years. At baseline, mean LVEF was 69% and mean GLS was -21%. Three months after epirubicin regimen, mean LVEF was 64% and mean GLS was -19%. Two patients already presented acute heart failure within one month after the end of epirubicin and one patient presented transient dyspnea during trastuzumab. At one year, mean LVEF was 63% and mean GLS was -19%. Nine patients presented CRCD. In these patients, mean LFEV was 51% at 12 months while mean LVEF was 64% at 3 months. Their mean GLS at 3 months was -15% and GLS variation was 24%. Statistical analysis showed that only GLS values and variation at 3 months were predictive of later cardiotoxicity (p<0,001). GLS of -17% (Se= 100% and Sp=88%) or a decrease of 19% in GLS (Se=100% and Sp= 88%) at 3 months were associated with the onset of CRCD at one year. The maximum additional effect of trastuzumab was noted at 3 months. There were five patients with CRCD in the trastuzumab group versus two patients in the remaining patients (p=0,06).
Conclusions
Decrease in GLS at 3 months after epirubicin chemotherapy was statistically associated with CRCD at one year. This provides an accurate tool to allow early prevention of Cardiotoxicity. Further studies should be conducted to identify the best cardioprotective molecules to be initiated in these patients before LVEF decrease.
Clinical trial identification
prospective study
Editorial acknowledgement
we think all authors for their contribution to the study
Legal entity responsible for the study
Department of Medical Oncology, Hospital Militaire de Tunis.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.