Serum Markers, Conventional Doppler Echocardiography and Two-dimensional Systolic Strain in the Diagnosis of Chemotherapy-Induced Myocardial Toxicity

pp 151-158

Abstract

Background
Left ventricular dysfunction is a serious complication of antineoplastic treatment with unfavorable impact in future clinical outcome. Early diagnosis of cardiotoxicity in patients receiving chemotherapy might be useful to define a strategy for the prevention of ventricular function impairment.

Objective
The aim of this study was to analyze the usefulness of serum markers [troponin T (TnT), BNP and NT-proBNP] and two-dimensional longitudinal (LS) and radial (RS) strain to detect ventricular systolic dysfunction in patients treated with cardiotoxic chemotherapy.

Methods
Thirty six patients [average age (±SD) 47±16 years, 42% men], with neoplastic disease with normal myocardial mass and left ventricular ejection fraction (LVEF) ≥55% receiving chemotherapy treatment, were prospectively included. Assessment of serum markers and echocardiography were performed before chemotherapy and at 2, 3, 4 and 6 months after onset of cancer treatment. The 6-month cardiotoxicity endpoint (EP) was defined as reduced LVEF according to international consensus.

Results
Seven patients reached the EP (19.4%). Endpoint predictors were: NT-proBNP at 4 months (positive EP (G1): 152 ±42 pg/ml vs. negative EP (G2) 61±38 pg/ml; p <0.001), BNP at 4 months (G1 41±12 pg/ml vs. G2 26±11 pg/ml; p <0.01), two-dimensional LS at 3 months (G1 –16.3±2.4% vs. G2 19.6±2.02%; p <0.01) and 4 months (G1 –15.9±1.77% vs. G2 19.9±2.2%; p <0.001), and two-dimensional RS at 4 months (G1 46.4±2.4% vs. G2 52±3.4%; p <0.001).

Conclusions
Natriuretic peptides and two-dimensional LS and RS were useful to predict mild ventricular systolic dysfunction in chemotherapy treated patients.