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. 2022 Feb 18;2(4):oeac008.
doi: 10.1093/ehjopen/oeac008. eCollection 2022 Jul.

Serial changes of layer-specific myocardial function according to chemotherapy regimen in patients with breast cancer

Mi-Na Kim  1 , So-Ree Kim  1 , Hee-Dong Kim  2 , Dong-Hyuk Cho  3 , Seung Pil Jung  4 , Kyong Hwa Park  5 , Seong-Mi Park  1
Affiliations

Serial changes of layer-specific myocardial function according to chemotherapy regimen in patients with breast cancer

Mi-Na Kim et al. Eur Heart J Open. .

Erratum in

Abstract

Aims: Chemotherapy-induced cardiotoxicity (CIC) is a significant complication, meanwhile myocardial damage might differ depending on chemotherapy agents and their timing. The aim of this study was to evaluate serial changes of layer-specific myocardial function in patients with breast cancer and their differences by the development time of CIC and chemotherapy agent.

Methods and results: A total of 105 consecutive patients with breast cancer (age: 52.3 ± 9.3 years) were enrolled. Chemotherapy-induced cardiotoxicity occurred in 20 (19%) patients during 6 months. Endocardial and midmyocardial functions decreased in patients with or without CIC, with patients with CIC showing greater decreases during follow-up. Global longitudinal strain (GLS) change at 3 months was the most sensitive parameter to detect CIC. When new development of CIC was analysed at 6 months, GLS was reduced earlier than the decrease of left ventricular ejection fraction. In patients with CIC who were treated with anthracycline-based regimen for 3 months, endocardial GLS markedly decreased at 3 months and continued to decrease until 6 months. Patients with CIC who received trastuzumab therapy after anthracycline therapy showed further reduction in endocardial GLS at the 6-month follow-up, which was not shown in patients with CIC who received taxane therapy subsequently.

Conclusion: Myocardial function assessed by strain decreased in all patients with breast cancer receiving chemotherapy. The endocardial layer was the most vulnerable to chemotherapy-induced myocardial damage. Functional impairment was more profound in patients with CIC who received sequential anthracycline-trastuzumab chemotherapy. Thus, early evaluation of left ventricular function might be necessary for all patients with breast cancer to detect CIC.

Keywords: Breast cancer; Cardiotoxicity; Chemotherapy; Endocardium; Strain.

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Figures

Figure 1
Figure 1
Flow chart showing the selection of patients.
Figure 2
Figure 2
Comparison of changes in LVEF between patients with CIC and those without CIC. The data were presented as estimated marginal with 95% confidence interval. *P < 0.001 for the difference in serial change of LVEF between patients with and without CIC. **P < 0.001 for the trend of LVEF in patients with CIC. †P < 0.05 for comparison between patients with and without CIC. CIC, chemotherapy-induced cardiotoxicity; LVEF, left ventricular ejection fraction.
Figure 3
Figure 3
Longitudinal and circumferential strain trends in patients with CIC and those without CIC during a 6-month follow-up. (A) Global longitudinal strain (GLS) of the endocardium, midmyocardium, and picardium (GLSendo, GLSmid, and GLSepi). (B) Global circumferential strain (GCS) of the endocardium, midmyocardium, and epicardium (GCSendo, GCSmid, and GCSepi). The data were presented as estimated marginal with 95% confidence interval. *P < 0.05 for differences in changes of layer-specific GLS and GCS between patients with CIC and those without CIC. **P < 0.05 for the trend of L(C)S in each group of patients. CIC, chemotherapy-induced cardiotoxicity; GCS, global circumferential strain; GLS, global longitudinal strain.
Figure 4
Figure 4
A comparison of epicardial to endocardial strain difference between patients with CIC and those without CIC during the 6-month follow-up. The epicardial to endocardial difference of global longitudinal strain (A) and global circumferential strain (B) at baseline and at the 3-month and 6-month follow-up. CIC, chemotherapy-induced cardiotoxicity.
None
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7–34. - PubMed
    1. Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, Baughman KL, Kasper EK. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000;342:1077–1084. - PubMed
    1. Doyle JJ, Neugut AI, Jacobson JS, Grann VR, Hershman DL. Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol 2005;23:8597–8605. - PubMed
    1. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM, Zamorano JL, Aboyans V, Achenbach S, Agewall S, Badimon L, Barón-Esquivias G, Baumgartner H, Bax JJ, Bueno H, Carerj S, Dean V, Erol Ç, Fitzsimons D, Gaemperli O, Kirchhof P, Kolh P, Lancellotti P, Lip GYH, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Roffi M, Torbicki A, Vaz Carneiro A, Windecker S; Document Reviewers. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail 2017;19:9–42. - PubMed
    1. Pizzino F, Vizzari G, Qamar R, Bomzer C, Carerj S, Zito C, Khandheria BK. Multimodality imaging in cardiooncology. J Oncol 2015;2015:263950. - PMC - PubMed