Early assessment of chemotherapyrelated cardiovascular toxicity: an integrated evaluation through global longitudinal strain and arterial stiffness study

Background. Cancer therapy is commonly complicated by cardiac damage and, at the same time, it may deteriorate vessels function, leading to an impaired cardiovascular coupling. Cardiac toxicity is generally evaluated by assessing left ventricular (LV) ejection fraction (FE). Recently, deformation imaging has been proposed for the detection of subtle systolic dysfunction. However, few studies analyzed the effects of cancer therapy through an integrated evaluation of heart and vessels. Purpose.The aim of the study was to evaluate myocardial and arterial function early after antracyclines administration. Methods. 35 women (mean age: 54±10) with breast cancer were enrolled. All received antracyclines (epirubicin, 500 mg/mq or doxorubinin 600 mg/mq) and, in different percentages, further antiblastic therapy: 5-fluorouracil (500 mg/mq, 35.7%), taxotere (75 mg/mq, 42.9%), ciclofosfamide (600 mg/mq, 89.3%) and trastuzumab (25%). Patients were evaluated at time 0-, 3- and 6-month after the start of the therapy. We used global longitudinal strain (GLS, EchoPac), as marker of preclinical LV systolic dysfunction, and pulse wave velocity (PWV), augmentation index (AI), and ß stiffness, derived by echotracking software (Aloka, Japan) as markers of arterial stiffness, measured on the carotid arteries. Repeated measures ANOVA analysis was used for comparing the data at each step during the follow-up. Results. Main results of the study are shown in the table. Although volumes, EF (p=ns) and BNP (p=ns) are not altered significantly after cancer therapy, GLS and troponin were instead modified since the first 3 months. Moreover, both carotid PWV and ß-stiffness index increased at 6 months. No differences were found with respects to the type of the therapy. Conclusions. A combined evaluation of cardiac and vascular function should be early started in patients receiving antracyclines.