Abstract
Asymptomatic diastolic dysfunction (DD) with preserved left ventricular ejection fraction (LVEF) is suspected to precede late cardiac events in cancer survivors treated by chemotherapy. We conducted the first multicenter study of early DD induced by chemotherapy. Patients who were candidates for standard dose chemotherapy were screened for the absence of cardiovascular risk factors, LVEF ≥50%, normal-for-age diastolic function at echocardiography (E/A ratio, E wave deceleration time; DT), normal levels of potential DD biomarkers like Nt-proBNP (≤125 pg/mL), and cardiac troponin I (cTnI, ≤0.05 ng/mL). Mitral Doppler (E/E’) was left at the investigator’s discretion. Chemotherapy-induced DD with preserved LVEF was diagnosed for patients showing LVEF ≥50% and any of the following: Nt-proBNP > 125 pg/mL, cTnI > 0.05 ng/mL, and out-of-range E/A and DT. Eighty patients (68 males, 12 females, median age 49 years) were evaluated at 1 week after chemotherapy (T1). Thirty-three protocol-defined diastolic events were observed (15 Nt-proBNP > 125 pg/mL, 14 grade I DD by E/A and DT, 4 cTnI > 0.05 ng/mL). The events occurred in 29 asymptomatic patients with LVEF ≥50% (36% incidence of DD with preserved LVEF). Interactions occurred between biomarkers and grade I DD. E/E’ abnormalities were not observed. Both anthracycline-based and nonanthracycline regimens induced DD. These findings show that biomarkers and echocardiography intercept early DD in otherwise asymptomatic low-risk cancer patients treated by standard dose chemotherapy. These findings therefore call for the adequate cardiac management of cancer patients.
| Original language | English |
|---|---|
| Pages (from-to) | 55-63 |
| Number of pages | 9 |
| Journal | Chemotherapy |
| DOIs | |
| Publication status | Accepted/In press - Feb 9 2018 |
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Keywords
- Biomarkers
- Cancer
- Cardiotoxicity
- Chemotherapy
- Diastolic dysfunction
- Echocardiography
ASJC Scopus subject areas
- Oncology
- Pharmacology
- Drug Discovery
- Pharmacology (medical)
- Infectious Diseases
Cite this
Early Diastolic Dysfunction after Cancer Chemotherapy : Primary Endpoint Results of a Multicenter Cardio-Oncology Study. / Calabrese, Vito; Menna, Pierantonio; Annibali, Ombretta; Armento, Grazia; Carpino, Armando; Cerchiara, Elisabetta; Greco, Carlo; Marchesi, Francesco; Spallarossa, Paolo; Toglia, Giuseppe; Reggiardo, Giorgio; Minotti, Giorgio.
In: Chemotherapy, 09.02.2018, p. 55-63.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Early Diastolic Dysfunction after Cancer Chemotherapy
T2 - Primary Endpoint Results of a Multicenter Cardio-Oncology Study
AU - Calabrese, Vito
AU - Menna, Pierantonio
AU - Annibali, Ombretta
AU - Armento, Grazia
AU - Carpino, Armando
AU - Cerchiara, Elisabetta
AU - Greco, Carlo
AU - Marchesi, Francesco
AU - Spallarossa, Paolo
AU - Toglia, Giuseppe
AU - Reggiardo, Giorgio
AU - Minotti, Giorgio
PY - 2018/2/9
Y1 - 2018/2/9
N2 - Asymptomatic diastolic dysfunction (DD) with preserved left ventricular ejection fraction (LVEF) is suspected to precede late cardiac events in cancer survivors treated by chemotherapy. We conducted the first multicenter study of early DD induced by chemotherapy. Patients who were candidates for standard dose chemotherapy were screened for the absence of cardiovascular risk factors, LVEF ≥50%, normal-for-age diastolic function at echocardiography (E/A ratio, E wave deceleration time; DT), normal levels of potential DD biomarkers like Nt-proBNP (≤125 pg/mL), and cardiac troponin I (cTnI, ≤0.05 ng/mL). Mitral Doppler (E/E’) was left at the investigator’s discretion. Chemotherapy-induced DD with preserved LVEF was diagnosed for patients showing LVEF ≥50% and any of the following: Nt-proBNP > 125 pg/mL, cTnI > 0.05 ng/mL, and out-of-range E/A and DT. Eighty patients (68 males, 12 females, median age 49 years) were evaluated at 1 week after chemotherapy (T1). Thirty-three protocol-defined diastolic events were observed (15 Nt-proBNP > 125 pg/mL, 14 grade I DD by E/A and DT, 4 cTnI > 0.05 ng/mL). The events occurred in 29 asymptomatic patients with LVEF ≥50% (36% incidence of DD with preserved LVEF). Interactions occurred between biomarkers and grade I DD. E/E’ abnormalities were not observed. Both anthracycline-based and nonanthracycline regimens induced DD. These findings show that biomarkers and echocardiography intercept early DD in otherwise asymptomatic low-risk cancer patients treated by standard dose chemotherapy. These findings therefore call for the adequate cardiac management of cancer patients.
AB - Asymptomatic diastolic dysfunction (DD) with preserved left ventricular ejection fraction (LVEF) is suspected to precede late cardiac events in cancer survivors treated by chemotherapy. We conducted the first multicenter study of early DD induced by chemotherapy. Patients who were candidates for standard dose chemotherapy were screened for the absence of cardiovascular risk factors, LVEF ≥50%, normal-for-age diastolic function at echocardiography (E/A ratio, E wave deceleration time; DT), normal levels of potential DD biomarkers like Nt-proBNP (≤125 pg/mL), and cardiac troponin I (cTnI, ≤0.05 ng/mL). Mitral Doppler (E/E’) was left at the investigator’s discretion. Chemotherapy-induced DD with preserved LVEF was diagnosed for patients showing LVEF ≥50% and any of the following: Nt-proBNP > 125 pg/mL, cTnI > 0.05 ng/mL, and out-of-range E/A and DT. Eighty patients (68 males, 12 females, median age 49 years) were evaluated at 1 week after chemotherapy (T1). Thirty-three protocol-defined diastolic events were observed (15 Nt-proBNP > 125 pg/mL, 14 grade I DD by E/A and DT, 4 cTnI > 0.05 ng/mL). The events occurred in 29 asymptomatic patients with LVEF ≥50% (36% incidence of DD with preserved LVEF). Interactions occurred between biomarkers and grade I DD. E/E’ abnormalities were not observed. Both anthracycline-based and nonanthracycline regimens induced DD. These findings show that biomarkers and echocardiography intercept early DD in otherwise asymptomatic low-risk cancer patients treated by standard dose chemotherapy. These findings therefore call for the adequate cardiac management of cancer patients.
KW - Biomarkers
KW - Cancer
KW - Cardiotoxicity
KW - Chemotherapy
KW - Diastolic dysfunction
KW - Echocardiography
UR - http://www.scopus.com/inward/record.url?scp=85042085917&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042085917&partnerID=8YFLogxK
U2 - 10.1159/000486761
DO - 10.1159/000486761
M3 - Article
AN - SCOPUS:85042085917
SP - 55
EP - 63
JO - Chemotherapy
JF - Chemotherapy
SN - 0009-3157
ER -