Cardiotoxicity in breast cancer treatment: What about left ventricular diastolic function and left atrial function?

Abstract

Aims Cardiotoxicity is a possible complication of cancer treatment, particularly with anthracyclines and anti‐HER2 drugs. Systolic dysfunction has already been described. Diastolic dysfunction and left atrial function are less studied. We sought to analyze the impact of cardiotoxic treatments on left ventricular diastolic function and left atrial (LA) function. Methods and Results Retrospective study of 100 patients (all women, with a mean age of 54 ± 12 years) with three exams in the span of 1 year during treatment for breast cancer. Patients with previous cancer treatment, coronary artery disease, significant valvular disease, and atrial arrhythmias were excluded. Diastolic dysfunction was classified according to international guidelines and left atrial strain was analyzed by two‐dimensional speckle tracking. In our sample, 74% received anthracyclines, 83% anti‐HER2, and 76% radiation treatment. In the follow‐up, 20% developed new or worsening diastolic dysfunction. Age was the only independent predictor (OR 1.93, 95% CI 1.04–3.58, P = .037). In left atrial function, only the contractile function was significantly reduced in 20.8% of the patients and age was also the only independent predictor, but with a protective effect (OR 0.51, 95% CI 0.28–0.91, P = .023). Conclusions During breast cancer treatment, 20% of the patients develop new or worsening diastolic dysfunction, being age the main determinant, suggesting higher impact of chemotherapy in older patients. Contractile left atrial function is also compromised but, in this case, age seems to be protective. Our results support a stricter surveillance in older patients together to eventually adjust chemotherapy regimens.

Early Diastolic Dysfunction in Breast Cancer Patients Undergoing Chemotherapy

“…A longer follow-up period will be necessary to establish the clinical outcomes of these patients, but DD abnormalities over time are associated with subsequent systolic dysfunction and cardiotoxicity. 7 It was also possible to observe that patients with baseline DD are less associated with reduced LVEF than those who develop DD throughout treatment, suggesting that baseline DD is not associated with subsequent systolic dysfunction, similarly to what Timóteo et al 16 and Upshaw et al 7 reported when following patients for 12 months and 6.5 years, respectively.…”

“…19 In turn, variations in the E/e' parameter are also linked to chronic conditions, 13,20 which justifies the absence of changes in both parameters in the present study. Timóteo et al 16 showed significant indexed LA volume changes, but not until later -on 12-month echocardiography follow-up.…”

Evaluation of left atrial function and mechanical dispersion in breast cancer patients after chemotherapy

“…Ana Teresa Timóteo et al suggested that no significant change in LA strain in breast cancer patients was observed after chemotherapy. 6 In contrast, Hyukjin Park et al suggested that a significant decline in LA strain developed after chemotherapy for breast cancer. 7 The respective changes in LASr, LAScd, and LASct in these patients is still a matter of debate.…”

Cardiotoxicity of anthracycline‑free targeted oncological therapies in HER2‑positive breast cancer (Review)

“…Although the peak global longitudinal and radial strain decreased, 10 patients demonstrated a reduction in lateral S' at 3 months after trastuzumab treatment, and these 10 patients all eventually developed trastuzumab-mediated cardiotoxicity. Retrospective studies have also shown that 20% of patients develop new or worsening diastolic dysfunction during breast cancer treatment (42,43). In the aforementioned studies, the diastolic dysfunction was evaluated by TDI indexes including mitral annular e'velocity (septal and lateral) and average E/e' ratio.…”