Early Diagnosis of Chemotherapy-induced Cardiomyopathy: a Prospective Tissue Doppler Imaging Study

Abstract

The aim of our study was to compare the applicability of the conventional echocardiography and a novel method, tissue Doppler imaging (TDI) in detection of late or subclinical cardiotoxicity following anthracycline chemotherapy in long-term follow up. Forty women (31 to 65 years) were enrolled, who had not received anthracyclines previously and had normal cardiac function. The control group consisted of 20 healthy persons of similar age range. In addition to standard echocardiographic measurements, each patient underwent specific measurements (E-septum separation, pulmonary venous flow) as well. Furthermore, the myocardial velocity of numerous segments of the mitral anulus obtained with pulsed wave TDI was also detected over a two-year-long period. Systolic left ventricular function did not change significantly either in the study or in the control group. After one year, diastolic left ventricular function was impaired in 39 patients (97.5%), and 29 (72.5%) of these showed clear changes by means of the traditional E/A ratio and TDI. However, in ten patients (25%) the diastolic dysfunction could only be detected with TDI. At the end of the study diastolic dysfunction was detected in each patient, but in 13 patients (32.5%) the relaxation disorder could be revealed only with TDI. Detectable myocardial damage occurred in the study group as a result of anthracycline therapy. Our results confirmed our assumptions that TDI is a more precise and useful examination method than the traditional ones (E/A ratio or deceleration time) to demonstrate isolated diastolic dysfunction. TDI may become a regularly and more widely used noninvasive method to detect subclinical cardiotoxicity emerging after chemotherapy.

Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

“…Several investigators have demonstrated an early reduction in e ′ velocity of the mitral annulus in patients receiving anthracyclines ( Figures 7C and 7D), 48,[150][151][152] which remained reduced during treatment 153 and for several years thereafter. 150 The reductions in e ′ velocity appear heterogeneous, 150,151,154 suggesting differences in regional wall stress, apoptosis, or fibrosis.…”

Early Detection and Prediction of Cardiotoxicity - Biomarker and Echocardiographic Evaluation

“…The applicability of the conventional and tissue Doppler echocardiography for detection of late or subclinical cardiotoxicity, following anthracycline chemotherapy was compared in forty women (Nagi et al, 2008). After one year diastolic left ventricular function was impaired in 97.5% of patients, and in 25% of them diastolic dysfunction could only be detected with TDI.…”

I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia

“…Disfunção diastólica por toxicidade cumulativa dosedependente pode ser observada com dose cumulativa equivalente a 200 mg/m 2 , enquanto disfunção sistólica é observada usualmente com doses acima de 400 mg/m 2 , com variabilidade segundo limiar individual 19 . Entretanto, prejuízo na função diastólica foi observado com dose cumulativa de apenas 120 mg/m 2 20 .…”