Assuntos
Técnicas de Imagem Cardíaca , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Imagem Multimodal , Miocárdio/patologia , Mixoma/diagnóstico por imagem , Mixoma/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Adulto , Idoso , Biópsia , Feminino , Neoplasias Cardíacas/fisiopatologia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/fisiopatologia , Mixoma/cirurgia , Valor Preditivo dos Testes , Sarcoma/fisiopatologia , Sarcoma/cirurgia , Resultado do TratamentoAssuntos
Ecocardiografia/métodos , Educação Médica Continuada/normas , Ventrículos do Coração/diagnóstico por imagem , Melhoria de Qualidade , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Academias e Institutos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Curva ROC , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Because cancer patients survive longer, the impact of cardiotoxicity associated with the use of cancer treatments escalates. The present study investigates whether early alterations of myocardial strain and blood biomarkers predict incident cardiotoxicity in patients with breast cancer during treatment with anthracyclines, taxanes, and trastuzumab. METHODS AND RESULTS: Eighty-one women with newly diagnosed human epidermal growth factor receptor 2-positive breast cancer, treated with anthracyclines followed by taxanes and trastuzumab were enrolled to be evaluated every 3 months during their cancer therapy (total of 15 months) using echocardiograms and blood samples. Left ventricular ejection fraction, peak systolic longitudinal, radial, and circumferential myocardial strain were calculated. Ultrasensitive troponin I, N-terminal pro-B-type natriuretic peptide, and the interleukin family member (ST2) were also measured. Left ventricular ejection fraction decreased (64 ± 5% to 59 ± 6%; P<0.0001) over 15 months. Twenty-six patients (32%, [22%-43%]) developed cardiotoxicity as defined by the Cardiac Review and Evaluation Committee Reviewing Trastuzumab; of these patients, 5 (6%, [2%-14%]) had symptoms of heart failure. Peak systolic longitudinal myocardial strain and ultrasensitive troponin I measured at the completion of anthracyclines treatment predicted the subsequent development of cardiotoxicity; no significant associations were observed for left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and ST2. Longitudinal strain was <19% in all patients who later developed heart failure. CONCLUSIONS: In patients with breast cancer treated with anthracyclines, taxanes, and trastuzumab, systolic longitudinal myocardial strain and ultrasensitive troponin I measured at the completion of anthracyclines therapy are useful in the prediction of subsequent cardiotoxicity and may help guide treatment to avoid cardiac side-effects.
