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Unveiling the Impact of Anthracycline Chemotherapy on Resting and Exercise Echocardiography
Session:
SESSÃO DE POSTERS 28 - ECOCARDIOGRAFIA DE STRESS
Speaker:
Margarida De Castro
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Cartazes
FP Number:
---
Authors:
MARGARIDA DE CASTRO; Luísa Pinheiro; Mariana Tinoco; Tamara Pereira; Mário Rui Lourenço; Filipa Castro; Filipa Cordeiro; Marina Fernandes; Alexandra Teixeira; Olga Azevedo; João Português; António Lourenço
Abstract
<p><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 concern for Breast Cancer (BC) patients (pts) undergoing anthracycline chemotherapy (AC). Current methods to detect CTRCD rely on resting echocardiographic (echo) parameters, such as LVEF or GLS, which have limited sensitivity in early stages. </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">Aim</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">: To evaluate AC impact on echo parameters at rest and exercise in order to identify ones with better sensitivity than LVEF and GLS to detect post-AC cardiac damage.</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 between May 2022 and December 2023. Each pt had 3 visits: before starting AC, 1-month after and at 6-months after completing AC. During each visit, they performed cardiopulmonary exercise test (CPET), resting and exercise echo. </span></span></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">During CPET, exercise echo images were obtained with the pt on the treadmill at different stages. An experienced echocardiographer, blinded to prior results, performed image acquisition. All echo measurements were performed offline by a single blinded interpreter. Inter- and intra-observer variabilities were assessed in 30% of randomized pts using an intraclass correlation coefficient (ICC).</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="background-color:white"><span style="font-family:"Times New Roman",serif">Results: </span></span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif">We included 32 women, 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 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) comparing to baseline. During peak exercise, 2D LVEF decreased from 70.3±5.3% to 66.6±5.8% at 1-month (p<0.001) and to 64.4±4.3% at 6-months (p<0.001). </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">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) and LV 3D-GLS 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). During exercise, LV 2D-GLS dropped from -19.0% to -17.3±1.5% at 1-month and -17.3±1.8 at 6-months (p<0.001).</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">Myocardial work (MWI) parameters (global work index (GWI) and global constructive work (GCW)) changed significantly at rest and during exercise at both 1 and 6-months <span style="background-color:white">(Table 1)</span>. </span></span></span></span><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">At rest, GWI showed a reduction from 1839±260 to 1607±288 at 1-month (p<0.001) and to 1588±277 at 6-months (p<0.001) and GCW from 2142±311 to 1899±300 at 1-month (p<0.001) and to 1874±311 at 6-months (p<0.001). </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">The intra- and inter-observer reproducibility of echocardiographic parameters was generally good or excellent. </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 style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Our study support the results of others showing that BC patients exposed to AC present significant reductions in LVEF, LV GLS and MWI both at rest and exercise. Peak exercise LVEF and GLS may be more sensitive and earlier markers of cardiac damage than LVEF and GLS at rest in these pts. </span></span></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">Beyond, AC cardiotoxicity is very early, being immediately visible in the first month and remaining sustained on FU. </span></span></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">Further research is necessary to fully understand the effects of AC on cardiac function. </span></span></span></span></p>
Slides
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