Left ventricular mechanical dyssynchrony after chemotherapy in breast cancer patients with normal rest gated SPECT-MPI.

OBJECTIVES: Early diagnosis of chemotherapy-induced cardiotoxicity plays an important role in preventing heart failure. The main aim of our study was to assess left ventricular (LV) dyssynchrony measured by phase analysis of gated single-photon emission computed tomography (SPECT) as an early sign of cardiotoxicity after breast cancer chemotherapy. METHODS: This cross-sectional study was conducted on patients with stage ≤ 3 breast cancer and no history of cardiovascular disease or diabetes. After mastectomy, the patients underwent rest gated SPECT myocardial perfusion imaging (MPI). Sixty patients with normal gated SPECT-MPI were selected and the imaging was performed after chemotherapy with doxorubicin, cyclophosphamide and paclitaxel. LV function and contractility parameters were extracted by QGS software and the results were compared with the t test method. The abnormality of at least one of the three phase analysis indices was considered as left ventricular dyssynchrony (LVD). RESULTS: The average LV end-systolic volume and ejection fraction (LVEF) before and after chemotherapy were (16.2 ± 8.0 ml and 21.6 ± 11.6 ml) and (73.4 ± 7.9% and 67.5 ± 9.2%) respectively, which showed a significant decrease (P < 0.05). In 2 patients (3.3%), the LVEF decreased to less than 50% after chemotherapy. The average parameters of left ventricular contractility before and after chemotherapy were, respectively, as follows: PHB (24.1 ± 7.5 and 33.8 ± 16.4), PSD (9.4 ± 6.1 and 5.7 ± 1.9) and entropy (28.9 ± 7.1 and 35.6 ± 9.7), which showed a significant increase (P < 0.05). LVD was observed in 14 patients (23.4%) after chemotherapy and prevalence of LVD was significantly higher in patients who had received a cumulative dose of doxorubicin of more than 400 mg/m2 (P = 0.005). There was no relationship between age and body mass index with the incidence of LVD after chemotherapy (P > 0.05). CONCLUSION: Using phase analysis of gated SPECT-MPI, chemotherapy-induced LVD was seen in a significant number of patients with breast cancer, especially with a high cumulative dose of doxorubicin. LVD might indicate chemotherapy-induced cardiotoxicity before LVEF becomes abnormal.

The Effects of Dietary Supplements of Calcium, Vitamin D and Estrogen Hormone on Serum Levels of OPG and RANKL Cytokines and their Relationship with Increased Bone Density in Rats.

INTRODUCTION: Osteoprotegerin (OPG)-Receptor activator of nuclear factor kappa-B ligand (RANKL) pathway is one of the contributing factors in the regulation of osteogenesis and bone resorption routes. AIM: The purpose of this study was to evaluate the effects of various dietary supplements on this pathway. MATERIALS AND METHODS: The samples for this study (24 newborn rats) were divided in three groups according to the experiment applied for each group. Rats were given special diet according to their group plan for six weeks. Blood samples were collected to measure their serum levels of OPG and RANKL and all organs of rats were used to measure their bone density too. The results were analysed using appropriate statistical analysing tests. RESULTS: Levels of whole-body bone mineral density in calcium plus vitamin D plus Estrogen (Ca + D + E) group and calcium plus vitamin D (Ca + D) group were significantly increased compared to control group. Mineral density was highest in calcium plus vitamin D plus Estrogen group and was about 0.1357 g/cm2. RANKL had a significant decrease in calcium plus vitamin D plus Estrogen group compared to control and calcium plus vitamin D groups. There was a significant increase in the mean calcium and OPG in both experimental groups rather than control. Also, significant increase in estrogen was observed in Ca + D group than the control group. CONCLUSION: The results showed that intake of calcium and vitamin D and estrogen at determined dose led to an increase in OPG and RANKL cytokines reduction which ultimately led to an increase in bone mineral density. But Ca, D and E synergies were more effective in increasing bone mineral density compared to only the use of Ca and D.

A Suggested Prototype for Assessing Bone Health.

BACKGROUND: Osteoporosis is becoming a health concern worldwide. Considering the fact that prevention plays an important role in reducing the burden of this silent disease and in view of the limited resources available, many countries have adopted certain programs to fight osteoporosis through shifting their attention towards at-risk individuals. The Iranian Multicenter Osteoporosis Study (IMOS) is one of these programs. The program aims to assess bone health and the prevalence of vitamin D deficiency in different parts of Iran with various altitudes, latitudes and lifestyle habits in a way that the results could be generalized to the country. METHOD: The present article presents the protocol used in the third phase of the study. It was designed based on the experiences gathered in the previous phases to overcome the shortcomings particularly subject loss. The questionnaire applied in this study was developed based on a thorough literature review of the risk factors and secondary causes of osteoporosis and was approved by an expert panel. RESULTS: While the majority of the existing studies aim to study a certain aspect of osteoporosis, the present protocol provides the information needed for policy makers and researchers to study different osteoporosis-related issues. CONCLUSION: The authors believe the protocol, to be implemented with small modifications, can help policymakers in different parts of the world, particularly developing countries, gather accurate information on different aspects of bone health at the national level.