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Curso de Atualização em Medicina Cardiovascular 2019
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Clinical impact of cardiotoxicity induced by chemotherapy in patients with breast cancer
Session:
Posters 3 - Écran 5 - Doença CV em populações especiais
Speaker:
Ana Filipa Abreu Cardoso
Congress:
CPC 2019
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Posters
FP Number:
---
Authors:
Ana Filipa Cardoso; Pedro von Hafe; Margarida Oliveira; Bebiana Faria; Geraldo Dias; Ana Sofia Rolo; Liliana Oliveira; Alexandra Teixeira; Ilda Faustino; Marina Fernandes; Olga Azevedo; António Lourenço
Abstract
<p><strong>Background and purpose: </strong>Breast cancer (BC) chemotherapy is associated with cardiotoxicity (CT), particularly with anthracyclines (AC) and trastuzumab (T). We aim to evaluate the frequency of CT and its clinical impact on BC patients.</p> <p><strong>Methods: </strong>Retrospective study of BC patients treated with AC and/or T in a single center in 2017. Patients with baseline left ventricular ejection fraction (EF) <50% were excluded. CT was defined as reduction of EF >10% to a value <50% or as relative reduction of global longitudinal strain (GLS) ≥15%.</p> <p><strong>Results: </strong>We included 69 women with mean age of 55 ± 11 years and mean body mass index (BMI) of 28±5 kg/m<sup>2</sup>, treated with AC (37; 53.6%), T (13; 18.8%) or AC followed by T (19; 27.5%).</p> <p>At the end of AC, there was a significant decrease in GLS (-21.5% vs -19.5%, <em>p=.001</em>), no change in EF (65% vs 63%, <em>p=.194</em>) or s’VD (<em>p=.309</em>). E/A ratio lowered (0.99 vs 0.79, <em>p=.001</em>) and deceleration time increased (203 vs 225ms, <em>p=.003</em>), but no changes on mean E/e´ (<em>p= .970</em>) or left atrial volume (<em>p=.093</em>) occurred. In patients under T/AC+T, systolic and diastolic parameters did not differ from baseline to after T treatment.</p> <p>Nevertheless, CT occurred in 15 patients (21.7%), including 2 under AC, 6 under T and 7 under AC+T. Of these, only 3 met the EF criteria for CT (1T, 2AC+T).</p> <p>Patients with CT had a lower BMI (25 vs 28 kg/m<sup>2</sup>, <em>p=.031</em>) and were more frequently treated with T (46.2%) and AC+T (36.8%) than with AC alone (5.4%) (<em>p=.001</em>). Baseline echo and clinical parameters were similar in CT and non-CT groups. Radiotherapy was not associated with CT.</p> <p>Among patients with CT, there was no heart failure (HF) or need to suspend therapy in patients under AC alone. However, in patients under T/AC+T, HF developed in 2 patients (15.4%) (1T, 1 AC+T) and 3 (23.1%) suspended treatment due to EF reduction (1T, 2AC+T).</p> <p>In a regression model, therapy with T (OR: 17.81; 95% CI 1.99 – 158.64, <em>p=.01</em>), AC+T (OR: 31.11; 95% CI 3.25-298.18, <em>p=.003</em>) and BMI <25 kg/m<sup>2 </sup>(OR: 0.06; 95% CI 0.01-0.38, <em>p=.003</em>) were associated with CT.</p> <p><strong>Conclusion:</strong> AC were associated to a significant decrease of GLS. CT occurred in 21.7%, mainly on T/AC+T patients, a frequency within literature data for CT under T/AC+T. Lower BMI and treatment with T and AC+T were predictors of CT. CT had clinical impact leading to HF and suspension of chemotherapy only in T/AC+T patients, in a higher frequency than described in the literature, which might be explained by sample size.</p>
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