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Early predictors of cardiotoxicity in patients under anthracyclines
Session:
Painel 12 -Cardio-Oncologia / Farmacologia 1
Speaker:
Cátia Costa Oliveira
Congress:
CPC 2020
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:
Cátia Costa Oliveira; Mariana Coelho; Inês Bernardo; Isabel Durães Campos; Paulo Medeiros; Carla Rodrigues; Rui Files Flores; Carlos Galvão Braga; Vitor Hugo Pereira; Jorge Marques
Abstract
<p><strong>Introduction:</strong> Left Ventricular Ejection Fraction (LVEF) is the most used parameter for the monitoring of anthracyclines induced cardiotoxicity but it requires significant myocardial damage to be affected. Therefore, it is important to study earlier markers for cardiotoxicity.</p> <p><br /> <strong>Objective:</strong> To identify the early markers of cardiotoxicity caused by anthracyclines .<br /> <br /> <strong>Methods:</strong> Systematic review. Research was performed on 3 databases (Pubmed, Embase and Medline) using a combination of terms (anthracyclines and cardiotoxicity and predictors and early detection), including articles from 2000 to May 2019. The inclusion criteria were human studies and anthracycline therapeutic regimens in any dosage, formulation or indication.<br /> We extracted information about the study population, intervention and results, using a data extraction platform specifically designed for this review.<br /> </p> <p><strong>Results:</strong> According to the evaluated studies, 2D-global longitudinal strain (GLS) (8 studies with 628 participants) is an early predictor of cardiotoxicity despite of the time used for its evaluation, being reduced in the first echocardiographic evaluation after the beginning of treatment (even when LVEF is normal). 1 study with 89 people evaluate 3D-GLS and it is also a predictor of early cardiotoxicity. In 2 studies with 200 participants, T-troponin (TnT) showed to early predict cardiotoxicity regardless of the time. 1 study with 75 people evaluate hs-TnT showing that it is an early predictor of cardiotoxicity. I-troponin (TnI) and hs-TnI also showed to predict early cardiotoxicity in 1 study with 82 and 43 people respectively. A study that combine values of 2D-GLS superior to -15.9 and hs-TnT>0.004 ng/mL showed its power to predict early cardiotoxicity with a specificity of 89%. A study combining a fall in 2D-GLS>10% and a rise on hsTnI showed to be an early cardiotoxicity predictor with a specificity of 97%. On the other hand, left atrial volume (2 studies with 182 participants), E/A ratio (6 studies with 432 participants) and NTproBNP (3 studies with 282 participants) were not early predictors of cardiotoxicity. Despite LVEF being a predictor of cardiotoxicity, this parameter is changed late in the course of the treatment according to the 5 studies with 377 participants analyzed.</p> <p><br /> <strong>Conclusions:</strong> This study confirms that LVEF is not a good marker of early cardiotoxicity and suggests the use of echocardiographic deformation parameters and biomarkers of cardiac injury for this purpose.</p>
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