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Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(1): 56-60 | DOI: 10.5152/akd.2014.5185  

Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer

Hayri Alıcı1, Ozan Balakan2, Süleyman Ercan3, Musa Çakıcı4, Fethi Yavuz5, Vedat Davutoğlu3
1Clinic of Cardiology, 25 Aralık State Hospital, Gaziantep-Turkey
2Department of Oncology, Faculty of Medicine, Sütçü İmam University; Kahramanmaraş-Turkey
3Department of Cardiology, Faculty of Medicine, Gaziantep University; Gaziantep-Turkey
4Department of Cardiology, Faculty of Medicine, Adıyaman University; Adıyaman-Turkey
5Clinic of Cardiology, Dr. Ersin Arslan State Hospital; Gaziantep-Turkey

Objective: Cardiac effects of chemotherapy are usually recognized after clinical symptom or sign occurrence in patients with breast cancer. In this study, we aimed to determine the potential subclinical cardiotoxic effects of chemotherapy that were given lower dosage than well known cardiac safety dosage limits in patients with breast cancer during early period.
 
Methods: Fifty-one patients consecutively enrolled to this prospective cohort study. All patients were diagnosed as breast cancer at oncology hospital in University of Gaziantep. Before chemotherapy, all of the patients underwent to detailed ECG and echocardiography (ECHO) examinations. After 6 months, detailed ECG and ECHO examinations were repeated and compared with baseline values. Statistical analysis was performed using Shapiro-Wilk tests, Student t-test and Spearman correlation test.
 
Results: The average age of patients was 51 and one was male. Statistically significant decrease in ejection fraction was found after treatment (62.3%±3.3 and 59.9%±5.9, p=0.002). Evaluation of diastolic parameters; significant increase in the transmitral A flow velocity and significant decrease of E/A ratio were observed on Doppler ECHO analysis (77.4±19.1 cm/sec versus 86±18 cm/sec, p<0.001; 1.01±0.3 versus 0.9±0.2, p=0.03, respectively). On tissue Doppler analysis we observed that significant reduction in the value of E’ and significantly increase E/E’ ratio were present (12.5±3.6 cm/sec versus 10.7±2.9 cm/sec, p=0.001; 6.6±2.9 versus 7.7±3.3, p=0.04, respectively).
 
Conclusion: Chemotherapy has detrimental subclinical effect on both of systolic and diastolic function in early six months period despite the prescription of lower dosage of chemotherapy than well-known cardiac safety dosage limits. Tissue Doppler imaging may be more sensitive than ECG, conventional ECHO and Doppler for determining the subclinical cardiac damage. 
 

Keywords: breast cancer, chemotherapy, echocardiography, tissue Doppler imaging, cardiotoxicity


Meme kanserinde kemoterapiye bağlı erken subklinik kardiyotoksisitenin değerlendirilmesi

Hayri Alıcı1, Ozan Balakan2, Süleyman Ercan3, Musa Çakıcı4, Fethi Yavuz5, Vedat Davutoğlu3
1Clinic of Cardiology, 25 Aralık State Hospital, Gaziantep-Turkey
2Department of Oncology, Faculty of Medicine, Sütçü İmam University; Kahramanmaraş-Turkey
3Department of Cardiology, Faculty of Medicine, Gaziantep University; Gaziantep-Turkey
4Department of Cardiology, Faculty of Medicine, Adıyaman University; Adıyaman-Turkey
5Clinic of Cardiology, Dr. Ersin Arslan State Hospital; Gaziantep-Turkey

Amaç: Meme kanseri tedavisinde kullanılan kemoterapilerin kardiyak etkileri genellikle semptomlar görülünce fark edilmektedir. Çalışmamızda meme kanserli hastalarda önerilen kardiyak güvenli doz limitinin altında verilen kemoterapinin erken dönem subklinik kardiyotoksik etkilerini belirlemeyi amaçladık.
 
Yöntemler: Prospektif kohort olan bu çalışmaya Gaziantep Üniversitesi Tıp Fakültesi Hastanesi’nde meme kanseri tanısıyla kemoterapi planlanan 51 hasta alındı. Tüm hastaların kemoterapi öncesi ayrıntılı EKG ve ekokardiyografi (EKO) bulguları kaydedildi. Tedavinin 6. ayında EKG ve EKO  tekrarlandı, bazal değerlerle karşılaştırıldı. İstatistiksel analiz Student t-test, Shapiro Wilk test ve Spearman korelasyon testi kullanılarak yapıldı.
 
Bulgular: Hastaların yaş ortalaması 51'di ve 1 hasta erkekti. Hastaların kemoterapi sonrası sol ventrikül sistolik fonksiyonlarında anlamlı bir azalma oldu (%62,3±3,3’e karşı %59,9±5,9, p=0,002). Diyastolik parametrelerin değerlendirmesinde; Doppler eko analizinde, transmitral A akım hızında artış, E/A oranında anlamlı bir azalma (sırasıyla, 77,4±19,1 cm/sn’ye karşı 86±18 cm/sn, p<0,001; 1,01±0,3’e karşı 0,9±0,2, p=0,03) izlendi. Doku Doppler görüntülemede; E’ değerinde anlamlı bir azalma ve E/E’ oranında anlamlı bir artış (sırasıyla, 12,5±3,6 cm/sn’ye karşı 10,7±2,9 cm/sn, p=0,001; 6,6±2,9’a karşı 7,7±3,3, p=0,04) görüldü.

 
Sonuç: Çalışmamıza göre, meme kanserli hastalarda kullanılan kemoterapinin önerilen kardiyak güvenli doz limitinin altında verilmesine rağmen kemoterapi sonrası hem sistolik hem diyastolik fonksiyonlar olumsuz etkilemektedir. Doku Doppler görüntüleme EKG, konvansiyonel EKO ve Dopplere göre kemoterapiye bağlı subklinik kardiyak hasarı göstermede daha duyarlıdır.


 


Anahtar Kelimeler: meme kanseri, kemoradyoterapi, ekokardiyografi, doku Doppler görüntüleme, kardiyotoksisite.


Hayri Alıcı, Ozan Balakan, Süleyman Ercan, Musa Çakıcı, Fethi Yavuz, Vedat Davutoğlu. Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer. Anatol J Cardiol. 2015; 15(1): 56-60


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