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Predictors of cardiotoxicity in patients with breast cancer: a prospective study
Session:
Sessão Especial – Prémio Melhor Poster Electrónico
Speaker:
Beatriz Valente Silva
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Beatriz Valente Silva; Andreia Magalhães; Miguel Nobre Menezes; Nuno Cortez-Dias; Paula Costa; Mariana Saraiva; Fausto j. Pinto; Manuela Fiúza
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Cardiotoxicity (CTX) is a well-established side effect of several antineoplastic drugs. Ejection fraction (EF) is not a good predictor of CTX because it does not detect early myocardial changes. Left ventricular global longitudinal strain (GLS) and biomarkers – both classical (troponin and NTproBNP) and emerging (such as galectin) – have been proposed, but its application remains ill-defined. This study aimed to evaluate predictors of CTX in patients (pts) with breast cancer submitted to chemotherapy (QT) or radiotherapy (RT).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Prospective single centre study of consecutive female pts with breast cancer and normal EF (≥55%) who underwent QT and/or RT. Pts were submitted to a clinical, laboratory and echocardiographic evaluation in baseline and at 1,3,6,9,12 and 24 months of follow-up and in 2021. Pts were included between 2012 and 2017. CTX was defined as a reduction of ≥10% in the setting of an EF <55% (1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> endpoint) or as a reduced EF alone (2</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> endpoint). MannWhitney and receiver operator curve were used for statistical analysis.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: A total of 134 female pts were included (mean age 52±12 years; 27% hypertension, 17% smoking and 15% dyslipidemia). Mean follow-up was 7±2 years. Cancer therapy included anthracycline (84%), cyclophosphamide (94%), paclitaxel (57%), docetaxel (34%) and trastuzumab (34%). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> and 2</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> endpoints occurred in 5% and 9% of pts, respectively. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The reduction of GLS in the 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> month was a predictor of decreased EF (OR 10, 95%CI 1.1-90, p=0.04). The cutoff value of -19% for GLS showed the best sensibility-specificity ratio. An abnormal GLS (<-19%) at 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> month predicts the long-term reduction in EF (p=0.014). GLS evaluated at 6 and 9 months was significantly lower in pts who achieved the 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> endpoint (p=0.011) and predicted CTX (p=0.048, OR:1.57; and p=0.025, OR:0.19, respectively).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">NTproBNP at 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> and 6</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>th</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> months were significantly higher in pts who achieved 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> endpoint (86 vs 323 and 80 vs 328 pg/ml; p=0.001). Troponin at 1,3,6 and 9 months was significantly higher in pts with both 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> and 2</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> endpoints (p<0.001). Pts with reduced EF at follow-up had higher galectin levels at baseline and 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> month (p=0.043). </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: GLS abnormalities as early as the 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> month after QT were predictive of CTX. Troponin, NTproBNP and Galectin were also significantly higher, from an early stage, in patients who developed CTX. Our study supports the use of deformation imaging and biomarkers for the early detection of CTX.</span></span></span></p>
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