Prognostic Impact of Global Longitudinal Strain and NT-proBNP on Early Development of Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy
Abstract
:1. Introduction
2. Methods and Materials
2.1. Study Population
- Age > 18 years
- Ist–IIIrd stage of breast cancer (non-metastatic disease)
- Qualification for chemotherapy regimens with conventional doxorubicin
- Normal systolic LV function (baseline LV EF ≥ 55%), no typical signs of heart failure before the onset of anticancer treatment
- Previous radiation therapy, involving the heart and previous chemotherapy
- Known significant LV and right ventricular (RV) dysfunction, severe valvular heart disease, arrhythmias, mental illness
- Contraindication for doxorubicin-based chemotherapy
- Poor-quality echocardiography windows
- AC (doxorubicin plus cyclophosphamide)
- AC-paclitaxel (doxorubicin plus cyclophosphamide followed by paclitaxel)
- AC-docetaxel (doxorubicin plus cyclophosphamide followed by docetaxel)
- FAC (5-FU plus doxorubicin plus cyclophosphamide)
- TAC (docetaxel plus doxorubicin plus cyclophosphamide)
- FAC-docetaxel (5-FU plus doxorubicin plus cyclophosphamide followed by docetaxel)
2.2. Echocardiography
2.3. Biochemical Markers
2.4. The Six-Minute Walking Test
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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All Patients (n = 85) | Noncardiotoxicity (n = 63; 74.1%) | Cardiotoxicity (n = 22; 25.9%) | p-Value | |
---|---|---|---|---|
Age, yrs | 54.5 ± 9.3 | 54.4 ± 8.5 | 54.6 ± 11.4 | 0.77 |
BMI, kg/m2 | 27.7 ± 5.5 | 27.8 ± 5.4 | 27.5 ± 5.8 | 0.79 |
CVD risk factors | ||||
AH, n (%) | 36 (42.4) | 21 (33.3) | 15 (68.2) | 0.004 |
Diabetes mellitus, n (%) | 16 (18.8) | 10 (15.9) | 6 (27.3) | 0.24 |
Smoking, n (%) | 17 (20.0) | 12 (19.1) | 5 (22.7) | 0.26 |
Family history of CVD, n (%) | 23 (27.1) | 12 (19.1) | 11 (50.0) | 0.005 |
Dyslipidemia, n (%) | 23 (27.1) | 14 (22.2) | 9 (40.9) | 0.89 |
Medications | ||||
ACE inhibitors/ARBs | 24 (28.2) | 16 (25.4) | 8 (36.4) | 0.33 |
β-blockers | 26 (30.6) | 14 (22.2) | 12 (54.5) | 0.005 |
Diuretics | 6 (7.1) | 3 (4.8) | 3 (13.6) | 0.18 |
Calcium channel blockers | 8 (9.4) | 4 (6.4) | 4 (18.2) | 0.10 |
NT pro-BNP (ng/L) | 94.8 ± 43.8 | 87.3 ± 44.3 | 113.7 ± 37.3 | 0.021 |
6MWT, m | 569.6 ± 59.4 | 579.3 ± 56.9 | 541.8 ± 59.0 | 0.005 |
Regimen | All Patients (n = 85) | Noncardiotoxicity (n = 63; 74.1%) | Cardiotoxicity (n = 22; 25.9%) | p-Value |
---|---|---|---|---|
AC | 8 (9.4) | 6 (9.5) | 2 (9.1) | 1.00 |
AC-paclitaxel | 55 (64.7) | 40 (63.5) | 15 (68.3) | 0.692 |
AC-docetaxel | 8 (9.4) | 7 (11.1) | 1 (4.5) | 0.674 |
FAC-docetaxel | 6 (7.1) | 5 (7.9) | 1 (4.5) | 1.00 |
TAC | 5 (5.9) | 2 (3.2) | 3 (13.6) | 0.107 |
FAC | 3 (3.5) | 3 (4.8) | 0 (-) | 0.565 |
Doxorubicin cumulative dose (mg/m2) | 233.9 ± 29.6 | 234.6 ± 30.1 | 231.3 ± 28.5 | 0.80 |
Variables | T0 | T1 | T2 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
All Patients (n = 85) | Cardiotoxicity | Cardiotoxicity | Cardiotoxicity | |||||||
No (n = 63; 74.1%) | Yes (n = 22; 25.9%) | p-Value | No (n = 63; 74.1%) | Yes (n = 22; 25.9%) | p-Value | No (n = 63; 74.1%) | Yes (n = 22; 25.9%) | p-Value | ||
LVEF (%) | 60.6 ± 1.8 | 60.1 ± 1.6 | 61.8 ±1.8 | <0.001 | 57.1 ± 1.4 ± | 54.0 ± 1.6 * | <0.001 | 55.8 ± 1.6 ±^ | 49.9 ± 2.1 *§ | <0.001 |
GLS (%) | −21.1± 0.5 | −21.1 ± 0.5 | −21.0 ± 0.5 | 0.52 | −19.3 ± 0.9 ± | −17.8 ± 0.4 * | <0.001 | −18.5 ± 0.9 ±^ | −16.5 ± 11.1 *§ | <0.001 |
LVEDD (mm) | 46.1 ± 3.9 | 45.9 ± 4.2 | 46.8 ± 2.6 | 0.018 | 46.2 ± 3.8 ± | 47.1 ± 3.0 | 0.04 | 46.6 ± 3.8 ±^ | 47.1 ± 3.9 | 0.019 |
LVEDD index (mm/m2) | 25.1 ± 2.8 | 24.8 ± 2.7 | 25.6 ± 2.8 | 0.17 | 25.0 ± 2.6 ± | 25.7 ± 2.9 | 0.21 | 25.5 ± 3.7 ±^ | 25.8 ± 3.0 | 0.20 |
MAPSE (mm) | 14.8 ± 1.9 | 14.7 ± 2.0 | 14.9 ± 1.4 | 0.68 | 13.9 ± 1.6 ± | 13.1 ± 1.0 * | 0.043 | 13.3 ± 1.7 ±^ | 13.0 ± 1.8 *§ | 0.30 |
S’ mean (cm/s) | 9.0 ± 1.3 | 9.1 ± 1.3 | 8.9 ± 1.2 | 0.98 | 8.4 ± 1.1 ± | 7.9 ± 1.1 * | 0.08 | 8.0 ± 1.2 ±^ | 7.6 ± 1.1 *§ | 0.18 |
E (cm/s) | 72.7 ± 16.7 | 72.5 ± 15.6 | 73.2 ± 19.8 | 0.50 | 70.0 ±13.8 ± | 69.4 ±12.4 * | 0.85 | 67.3 ± 14.0 ±^ | 66.3 ± 11.3 * | 0.85 |
A (cm/s) | 73.7 ± 17.7 | 75.0 ± 17.9 | 70.1 ± 17.2 | 0.29 | 76.2 ± 14.7 | 73.6 ± 14.8 | 0.46 | 79.0 ± 17.6 ± | 74.0 ± 17.7 | 0.30 |
E/A ratio | 1.07 ± 0.4 | 1.04 ± 0.4 | 1.15 ± 0.3 | 0.08 | 0.96 ± 0.3 ± | 0.98 ± 0.3 * | 0.40 | 0.89 ± 0.3 ±^ | 0.95 ± 0.3 *§ | 0.29 |
E’ mean (cm/s) | 11.4 ± 2.3 | 11.4 ± 2.4 | 11.6 ± 2.1 | 0.88 | 10.3 ± 2.1 ± | 10.3 ± 1.9 * | 0.86 | 9.7 ± 2.1 ±^ | 10.0 ± 2.4 *§ | 0.98 |
E/E’ ratio | 6.7 ± 1.4 | 6.7 ± 1.4 | 6.9 ± 1.3 | 0.79 | 6.9 ± 1.3 ± | 6.8 ± 1.0 | 0.22 | 7.3 ± 1.6 ±^ | 7.2 ± 1.4 | 0.89 |
Variable | Univariate | Multivariate | ||
---|---|---|---|---|
OR [95% CI] | p-Value | OR [95% CI] | p-Value | |
GLS ≤ −18.0% | 30.933 [8.350–114.4590] | <0.001 | 12.849 [2.783–59.326] | 0.001 |
NT-proBNP > 125 ng/L | 11.864 [2.487–56.595] | <0.001 | 7.091 [1.034–48.642] | 0.046 |
Family history of CVD | 4.250 [1.493–12.095] | 0.005 | 2.874 [0.615–13.417] | 0.18 |
AH | 4.286 [1.517–12.112] | 0.004 | 1.299 [0.300–18.105] | 0.73 |
6MWT ≤ 515 m | 7.200 [2.405–21.554] | <0.001 | 3.704 [0.758–9.777] | 0.11 |
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Muckiene, G.; Vaitiekus, D.; Zaliaduonyte, D.; Zabiela, V.; Verseckaite-Costa, R.; Vaiciuliene, D.; Juozaityte, E.; Jurkevicius, R. Prognostic Impact of Global Longitudinal Strain and NT-proBNP on Early Development of Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy. Medicina 2023, 59, 953. https://doi.org/10.3390/medicina59050953
Muckiene G, Vaitiekus D, Zaliaduonyte D, Zabiela V, Verseckaite-Costa R, Vaiciuliene D, Juozaityte E, Jurkevicius R. Prognostic Impact of Global Longitudinal Strain and NT-proBNP on Early Development of Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy. Medicina. 2023; 59(5):953. https://doi.org/10.3390/medicina59050953
Chicago/Turabian StyleMuckiene, Gintare, Domas Vaitiekus, Diana Zaliaduonyte, Vytautas Zabiela, Raimonda Verseckaite-Costa, Dovile Vaiciuliene, Elona Juozaityte, and Renaldas Jurkevicius. 2023. "Prognostic Impact of Global Longitudinal Strain and NT-proBNP on Early Development of Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy" Medicina 59, no. 5: 953. https://doi.org/10.3390/medicina59050953