Electrocardiographic Characteristics of Breast Cancer Patients Treated with Chemotherapy

Abstract

Introduction. Patients receiving chemotherapy for breast cancer may be at risk of developing cardiac dysfunction and electrophysiological abnormalities. The aim of this study is to evaluate alterations in electrocardiographic (ECG) parameters in breast cancer patients receiving chemotherapy. Materials and Methods. This was a prospective single-center cohort study conducted in the Fourth Hospital of Hebei Medical University, China. Participants with breast cancer referred for chemotherapy from May 1, 2019, to October 1, 2019, were invited to participate in the study. Standard 12-lead ECG and echocardiography were performed at baseline or before chemotherapy (prechemotherapy) (T0), after 1 cycle (T1), after 3 cycles (T2), and at the end of chemotherapy (T3). Results. A total of 64 patients with diagnosed breast cancer undergoing chemotherapy were included. Echocardiographic parameters showed no significant variation during the entire procedure (all P > 0.05 ). The incidence of abnormal ECG increased from 43.75% at baseline to 65.63% at the end of chemotherapy, of which only the prevalence of fragmented QRS (fQRS) was significantly increased after the drug regimen (26.56% to 53.13%). At the end of the treatment, heart rate, P-wave dispersion, corrected QT interval, T-peak to T-end, RR, SV1, RV5, Sokolow–Lyon index (SLI), and index of cardioelectrophysiological balance deteriorated markedly (all P < 0.05 ). The area under the curve for SLI and QT dispersion (QTd) derived by ECG was 0.710 and 0.606, respectively. The cutoff value with 2.12 of SLI by ECG had a sensitivity of 67.2% and specificity of 71.9% for differentiating patients after therapy from baselines. The cutoff value with 0.55 of QTd had a sensitivity of 60.9% and specificity of 60.9%. Conclusions. The current study demonstrated that ECGs can be used to detect electrophysiological abnormalities in breast cancer patients receiving chemotherapy. ECG changes can reflect subclinical cardiac dysfunction before the echocardiographic abnormalities.

Electrocardiographic characteristics of bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy

“…myocardial fibrosis, the proportion of fQRS was also increased significantly after chemotherapy in patients with DLBCL (15.8% to 28.9%, p = .041) and breast cancer (26.6% to 53.1%, p < .01; Chen et al, 2020;Das et al, 2008;Liang et al, 2020). However, the clinical significance of fQRS may vary depending on its different distribution in the coronary artery territory.…”

Increased Prevalence of Fragmented QRS in Randomly Selected Group of Multiple Myeloma Patients: A Pilot Study to Assess Prevalence

“…More importantly and based on a mechanistic point of view, identification of fQRS in breast cancer [ 10 , 11 ] and non-Hodgkin lymphoma patients treated with R-CHOP regimens [ 12 ] were the drivers that prompted our interest in conducting this pilot analysis among an unselected group of MM patients, at different stages of their treatment, particularly when the incidence of MM has continued to increase based on findings recently published from studies assessing the global burden of MM since 1990 [ 23 ]. Furthermore, the undeniable reality that MM is occurring in younger patients (median age at diagnosis 70 years old [ 14 , 23 , 24 ] is critically important as MM clinical outcomes, not only are these dependent on each individual patient's overall fitness and underlying health status but also, age with a recognized cut off < 65 years, is a good prognostic marker [ 25 ].…”

“…The presence of fQRS was later identified among 40.8% of non-Hodgkin lymphoma patients treated with R-CHOP regimens [ 12 ]. Based on these findings, the investigators conducting this study proposed that the development of the fQRS pattern in response to cancer therapy might be considered as a potential new tool for the noninvasive assessment of potentially related chemotherapy-induced cardiotoxicities [ 12 ].…”

Ventricular Arrhythmia in Cancer Patients: Mechanisms, Treatment Strategies and Future Avenues

“…22,23 The prevalence of fQRS ranges from 1% to 30% in the general population, with a much higher prevalence in cancer patients after treatment with chemotherapy. 24 Given that myocardial fibrosis is an adverse effect of cancer therapy and chemotherapies can trigger apoptosis or necrotic myocyte death, studies have reported the importance of fQRS to recognise chemotherapy-related cardiotoxicities even preceding development of cardiac symptoms or echocardiographic abnormalities. 25,26…”