Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity

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Abstract

Background: High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity. Methods: In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF <50% and > 10 absolute units reduction) and to Group B (LVEF ≥ 50%). Results: Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a ≥ 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50%. Conclusions: In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.

Original languageEnglish
Pages (from-to)120-126
Number of pages7
JournalInternational Journal of Cardiology
Volume111
Issue number1
DOIs
Publication statusPublished - Jul 28 2006

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Dobutamine
Stroke Volume
Drug Therapy
Stress Echocardiography
Cardiotoxicity
Neoplasms
Breast Neoplasms

Keywords

  • Dobutamine
  • High-dose chemotherapy
  • Left ventricular contractile reserve
  • Left ventricular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{59068667b100493ba1ecdf21590b20f6,
title = "Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity",
abstract = "Background: High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity. Methods: In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF <50{\%} and > 10 absolute units reduction) and to Group B (LVEF ≥ 50{\%}). Results: Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a ≥ 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50{\%}. Conclusions: In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.",
keywords = "Dobutamine, High-dose chemotherapy, Left ventricular contractile reserve, Left ventricular dysfunction",
author = "Maurizio Civelli and Daniela Cardinale and Alessandro Martinoni and Giuseppina Lamantia and Nicola Colombo and Alessandro Colombo and Sara Gandini and Giovanni Martinelli and Cesare Fiorentini and Cipolla, {Carlo M.}",
year = "2006",
month = "7",
day = "28",
doi = "10.1016/j.ijcard.2005.07.029",
language = "English",
volume = "111",
pages = "120--126",
journal = "International Journal of Cardiology",
issn = "0167-5273",
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number = "1",

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TY - JOUR

T1 - Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity

AU - Civelli, Maurizio

AU - Cardinale, Daniela

AU - Martinoni, Alessandro

AU - Lamantia, Giuseppina

AU - Colombo, Nicola

AU - Colombo, Alessandro

AU - Gandini, Sara

AU - Martinelli, Giovanni

AU - Fiorentini, Cesare

AU - Cipolla, Carlo M.

PY - 2006/7/28

Y1 - 2006/7/28

N2 - Background: High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity. Methods: In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF <50% and > 10 absolute units reduction) and to Group B (LVEF ≥ 50%). Results: Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a ≥ 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50%. Conclusions: In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.

AB - Background: High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity. Methods: In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF <50% and > 10 absolute units reduction) and to Group B (LVEF ≥ 50%). Results: Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a ≥ 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50%. Conclusions: In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.

KW - Dobutamine

KW - High-dose chemotherapy

KW - Left ventricular contractile reserve

KW - Left ventricular dysfunction

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U2 - 10.1016/j.ijcard.2005.07.029

DO - 10.1016/j.ijcard.2005.07.029

M3 - Article

VL - 111

SP - 120

EP - 126

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 1

ER -