The Clinical Value of Echocardiography and Acoustic Cardiography to Monitor Patients Undergoing Anthracycline Chemotherapy

Abstract

Background: Investigate the usefulness of echocardiography and acoustic cardiography to monitor patients exposed to anthracycline chemotherapy. Hypothesis: Serial echocardiographies to monitor systolic function may not be neccessary in all patients undergoing anthracycline chemotherapy. Methods: In a prospective study, consecutive patients undergoing anthracycline-containing chemotherapy were evaluated with echocardiography and acoustic cardiography at baseline, after completion of chemotherapy, and after a median follow-up of 3.8 years. Systolic dysfunction was defined as a left ventricular ejection fraction ≤50%. Results: A total of 187 patients (83% female) with a mean age of 55 ± 14 years underwent chemotherapy for breast cancer (73%), malignant lymphoma (23%), and sarcoma (4%). None of the patients had systolic dysfunction at baseline. Patients were treated with doxorubicin 276 ± 74 mg/m 2 or epirubicin 317 ± 55 mg/m 2 .After chemotherapy, 170 (91%) had normal systolic function, 8 (4%) developed systolic dysfunction, and 9 (5%) had died. Of those 8 patients with systolic dysfunction, 4 (50%) improved to normal systolic function, 1 (13%) remained unchanged, and 3 (37%) died. Patients with normal systolic function after chemotherapy had a mortality rate of 3.5%, and 1.8% developed late systolic dysfunction. Acoustic cardiography-derived percent electromechanical activation time >12.4% had a sensitivity of 88% and a specificity of 84% to identify patients with systolic dysfunction (area under the receiver operating characteristic curve 0.87). Conclusions:Patients with systolic dysfunction early after anthracycline treatment had worse outcome. Acoustic cardiography was able to identify these patients with a high sensitivity and specificity. Based on the findings of this study, we propose a simple algorithm to monitor patients undergoing anthracycline-containing chemotherapy.

Cardiovascular risk factors among cancer patients qualified for systemic treatment. Analysis of a cardiovascular disease-free cohort from the Polish multicentre study ONCOECHO

“…Toggweiler et al showed in a heterogeneous group of 187 patients (breast cancer, malignant lymphoma, sarcoma) at baseline, before chemotherapy, the presence of arterial hypertension in 13% and coronary artery disease in 3%. Additionally, patients with these factors more often developed systolic heart failure [16]. In our whole group arterial hypertension was remarkably more frequent, at 34%.…”

Value of acoustic cardiography in the clinical diagnosis of coronary heart disease

“…[20][21][22][23] Other studies show that monitoring with acoustic cardiography can be used as a fast, simple, and effective method to predict early systolic dysfunction and to screen patients with sleep apnea syndrome. [24][25][26] In conclusion, S4 strength combined with ST-T changes of the ECG can improve the diagnosis of coronary heart disease; Acoustic cardiography can be used as a fast, simple, inexpensive and effective method to diagnose asymptomatic LVSD in the early weeks after AMI.…”

Phonocardiography: new opportunities in the light of digital technologies

“…После химиотерапии систолическая дисфункция развилась у 8 (4%) больных; в 1,8% случаев возникла поздняя систолическая дисфунк-ция. Показатель % EMAT позволял выявлять пациентов с систолической дисфункцией с чувствительностью 88% и специфичностью 84% [22].…”