The concurrent use of aromatase inhibitors and radiotherapy induces echocardiographic changes in patients with breast cancer

Abstract

Aim: Adjuvant radiotherapy (RT) for left-sided breast cancer has a negative impact on cardiac health. The concurrent use of aromatase inhibitors (AIs) during RT was found to increase the anticancer efficacy of radiation in pre-clinical models. We evaluated whether the acute effects of RT on cardiac functions are augmented by the concurrent use of AIs.

Patients and methods: Sixty patients with early-stage left-sided breast cancer underwent a 2D echocardiography, electrocardiogram and cardiac biomarker measurements before and after adjuvant breast RT. Data were analyzed in two groups according to AI use.

Results: We observed a significant (p<0.05) decrease in right ventricular systolic function during RT in tricuspid annular plane systolic excursion (TAPSE). TAPSE decreased by 3.0 mm [95% confidence interval (CI)=1.9-4.1 mm] in the AI group and 1.4 mm (95% CI=0.3-2.4 mm) in the non-AI group. In addition, left ventricular diastolic function decreased among patients using AI, as the mitral inflow E-wave decreased 5.8 cm/s (95% CI=1.8-9.7 cm/s) (p=0.006).

Conclusion: The concurrent use of AI during RT for left-sided breast cancer led to a more pronounced change on right ventricular systolic function and left ventricular diastolic functions compared to RT alone.

Keywords: Breast cancer; aromatase inhinitors; cardiotoxicity; radiotherapy.