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The Hidden Cost of Anthracyclines: Cardiac Dysfunction and Functional Impairment in Breast Cancer
Session:
SESSÃO DE POSTERS 23 - INSUFICIÊNCIA CARDÍACA E HIPERTENSÃO PULMONAR: DUAS ÁREAS DE INTENSOS AVANÇOS CIENTÍFICOS
Speaker:
Margarida De Castro
Congress:
CPC 2025
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Cartazes
FP Number:
---
Authors:
MARGARIDA DE CASTRO; Luísa Pinheiro; Mariana Tinoco; Tamara Pereira; Mário Lourenço; Liliana Oliveira; Mafalda Cunha; Geraldo Dias; Filipa Almeida; Olga Azevedo; João Português; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Introduction: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Cancer therapy-related cardiac dysfunction (CTRCD) is a prevalent and serious concern for Breast Cancer (BC) patients undergoing anthracycline chemotherapy (AC). However, current methods to detect CTRCD rely on resting echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), which have limited sensitivity in early stages of cardiac damage. Cardiorespiratory fitness (CRF) is a strong predictor of quality of life (QoL), heart failure (HF) and mortality in cancer patients, and is being explored for its potential to detect post-AC cardiac damage in BC patients. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Purpose: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">To evaluate the effects of AC on CRF in BC patients and to compare the value of impaired CRF to CTRCD criteria as a marker of cardiac damage in these patients. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">: Prospective study including women with early-stage BC undergoing AC, who underwent CPET and resting echocardiographic evaluation at three visits: before AC, 1-month and 6-months after completing AC.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">CTRCD was defined according to ESC cardio-oncology guidelines (table 1). CRF was evaluated by cardiopulmonary exercise test (CPET). CPETs were considered maximal if at least two criteria were met: (1) reaching the maximal predicted HR, (2) achieving a respiratory exchange ratio (RER) of 1.05 or higher, or (3) experiencing respiratory exhaustion. Functional disability (FD) was defined as a VO2peak ≤18.0mL/kg/min. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Results: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">We included 32 women <span style="background-color:white">with a mean age of 50.8±9.3 years</span>.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Significant reductions were observed in both 2D and 3D LVEF at 1-month (2D: 63.3±3.0% to 61.0±4.0%, p=0.007; 3D: 62.8±4.9% to 61.0±4.4%, p=0.020) and at 6-months (2D: 60.9±5.0%, p=0.031; 3D: 59.5±5.9%, p=0.003). LV 2D-GLS showed a reduction from -19.9±1.9% to -18.5±1.9% at 1-month (p=0.003) and to -18.4±2.1% at 6-months (p<0.001). LV 3D-GLS decreased from -19.5±1.8% to -17.4±2.7% at 1-month (p<0.001) and to -18.2±2.9% at 6-months (p=0.002). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">CTRCD was detected in 68.8% (n=22) (LVEF/GLS/biomarker criteria: n=0/6/17) at 1 month and in 18.8% (n=6) at 6 months (LVEF/GLS/biomarker criteria: n=0/5/3). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">FD increased from 9% pre-AC to 44% at 1-month and 53% at 6-months post-AC. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Patients with FD exhibited higher frequency of CTRCD at 1 month (85.7% vs. 55.5%; p<0.05) and at 6-months (35.3% vs. 0%; p<0.05). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">In univariate analysis, GLS and LVEF were not related to CRF. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Conclusions: </span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">CTRCD criteria detect cardiac damage in 68.8% at 1 month, while FD detects in only 44%, so CTRCD seems more sensitive for cardiac damage detection in an early stage.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">At 6-months post-AC, 53% of the patients had FD, while only 18.8% were diagnosed with CTRCD, suggesting that, with the current definition of CTRCD, many cases with potential long-term HF risk and morbimortality may be missed.</span></span><strong> </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Therefore, our study shows that CTRCD and FD criteria may have a complementary role in the evaluation of cardiac damage of AC in BC patients</span></span></span></span></p>
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