Echocardiographic strategy for early detection of cardiotoxicity of doxorubicin: a prospective observational study

Abstract

Background Cancer chemotherapy using anthracyclines is associated with cardiotoxicity (CTX), and left ventricular ejection fraction (LVEF) analysis is not sensitive to early cardiotoxic changes. Left ventricular global longitudinal strain (LV GLS) monitoring helps screen subclinical CTX; however, the intervals at which it should be performed remain unclear. We aimed to evaluate the incidence of CTX in women with breast cancer and the associated factors and compare two echocardiographic monitoring strategies using two cutoff points for LV GLS variation. Methods Patients with breast cancer prescribed doxorubicin underwent serial LVEF and LV GLS assessments using two-dimensional echocardiography every 3 weeks for 6 months. Results We included 43 women; none developed a clinical CTX. Considering a relative reduction of LV GLS > 15%, subclinical CTX was present in 12 (27.9%) and six (14%) patients at 3-week and 3-month intervals, respectively (P = 0.28). Additionally, considering a reduction of > 12%, subclinical CTX was present in 17 (39.5%) and 10 (23.3%) patients (P = 0.16), respectively. There were no significant differences in either reference value at 3-week (P = 0.19) and 3-month intervals (P = 0.41). Age ≥ 60 years (P = 0.018) and hypertension (HTN) (P = 0.022) were associated with subclinical CTX in the univariate analysis. Conclusions There was no difference in the incidence of subclinical CTX between the two cutoff points and no benefit in performing echocardiography every 3 weeks compared with quarterly monitoring. Advanced age and HTN were associated with the development of subclinical CTX.

Evaluating the Acute Toxicity and In vivo Protective Effect of Standardized Andrographis paniculata Extract against Doxorubicin-induced Cardiotoxicity in Sprague-dawley Rats

“…Echocardiography, a non-invasive method for assessing heart function, is widely used by clinicians to detect abnormalities in cardiac function during chemotherapy. 37 Left ventricular function is evaluated through measurements of left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and heart rate. Several clinical and animal studies have reported the use of echocardiographic parameters to diagnose DOX-induced cardiotoxicity.…”

“…Several clinical and animal studies have reported the use of echocardiographic parameters to diagnose DOX-induced cardiotoxicity. 37,38 Studies in rats have shown that DOX treatment leads to a decline in heart rate (beats/min), LVEF, and LVFS. 38,39 Similarly, this study observed a significant decrease in heart rate (244±17), LVEF (69.8±3%), and LVFS (29.5±2%) following DOX treatment.…”

Monitoring Values of Routine Echocardiography and Two-dimensional Speckle Tracking Imaging in Cardiotoxicity Caused by Treatment of Breast Carcinoma with Anthracyclines

“…Echocardiography (ECG) can be utilized to display cardiac anatomical structure and hemodynamics changes and assess cardiac functions. The main monitoring and assessment indicators for cardiotoxicity are ventricular diastolic and systolic functions, especially left ventricular ejection fraction (LVEF) [9]. According to relevant research, routine ECG has some application values in the monitoring of cardiotoxicity after ANTH chemotherapy [10].…”