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Relationship between echocardiographic outcomes and cardioprotective drugs in a population of female breast cancer patients exposed to anthracyclines
Session:
Comunicações Orais - Sessão 05 - Doença cardiovascular na mulher
Speaker:
Cátia Oliveira
Congress:
CPC 2023
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.2 Cardiovascular Disease in Women
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Cátia Oliveira; Pedro Palma; Luís Santos; Ana Pinho; Sara Costa; Sara Maia; André Cabrita; Catarina Marques; Ana Filipa Amador; Catarina Costa; João Calvão; Ricardo Pinto; Mariana Paiva; Carla Sousa; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Anthracyclines (AC) have been widely studied as a cause of cancer therapy-related cardiac dysfunction (CTRCD) in patients with breast cancer. Nonetheless, the role of cardioprotective drugs (CPD) as primary prevention is not well understood. We aimed to evaluate the impact of CPD in preventing CTRCD and on echocardiographic outcomes in female breast cancer patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>A retrospective cohort of breast cancer female patients treated with AC referred to Cardio-Oncology outpatient clinic from January 2017 to November 2021 was selected. All patients were evaluated with echocardiogram, high sensitivity troponin I(hs-cTnI) and BNP before treatment initiation, at 3 and 6 months and at 12-months after completing oncologic treatment. CTRCD was defined as LV ejection fraction<50% and/or global longitudinal strain (GLS) variation>15% during follow-up. As CPD we considered renin-angiotensin-aldosterone system inhibitors and beta-blockers.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 274 patients were included with mean age of 49.9±10.3 year-old. Most patients had a low cardiotoxicity risk. At baseline, median hs-cTnI was 1.9 (IQR 1.9-2.3)ng/L, median BNP 17 (IQR 10.0-32.9)pg/L, mean LVEF 62.9±3.5% and mean GLS -19.77±8.4%. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During follow-up (15.5±5.3 months), 30.5% of patients developed CTRCD. The overall prevalence of CTRCD was similar in patients on AC and on AC plus anti-HER2 therapy (AHT) (27.2% vs 35.9%, p=0.131), but CTRCD was more severe in the AC plus AHT group (moderate/severe CTRCD 1.8% vs 7.8%, p=0.038). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CPD was initiated or titrated in 35.8% of patients and 2.6% needed to suspend AHT; overall 59.3% of CTRCD patients recovered. When comparing patients already medicated with CPD prior to CTRCD development to those naïve of CPD, the first group presented a significantly lower incidence of CTRCD [20% vs 36.6%, p=0.005, OR=0.43 (95% CI 0.24– 0.78)]. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Analyzing the whole sample, LVEF at 12 months was similar regardless of CTRCD development (59.9% vs 61%, p=0.84). However, GLS at 12 months was significantly lower in the CTRCD group (-16.7% vs -19.2%, p<0.001). The risk of developing CTRCD was 24% per patients-year.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Patients exposed to AC had higher risk of developing CTRCD, which was more severe when concurrently on AHT therapy. Pre-treatment with CPD was significantly associated with a lower prevalence of CTRCD and with better echocardiographic outcomes regarding LVEF, but not GLS, in patients who developed CTRCD. These results highlight the importance of cardiac evaluation in AC patients and strengthen the value of primary prevention but also the need to investigate new therapies that might improve outcomes regarding GLS.</span></span></p>
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