Potential role of epicardial adipose tissue as a biomarker of anthracycline cardiotoxicity

Background We investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity. Methods We reviewed BC patients treated with anthracyclines who underwent CT before (CT-t0) and after (CT-t1) chemotherapy, and age- and sex-matched controls who underwent two CT examinations at comparable intervals. On non-contrast scans, EAT was segmented contouring the pericardium and thresholding between -190 and -30 Hounsfield units (HU), and SAT and VAT were segmented with two 15-mm diameter regions of interest thresholded between -195 and -45 HU. Results Thirty-two female patients and 32 controls were included. There were no differences in age (p = 0.439) and follow-up duration (p = 0.162) between patients and controls. Between CT-t0 and CT-t1, EAT density decreased in BC patients (-66 HU, interquartile range [IQR] -71 to -63 HU, to -71 HU, IQR -75 to -66 HU, p = 0.003), while it did not vary in controls (p = 0.955). SAT density increased from CT-t0 to CT-t1 in BC patients (-107 HU, IQR -111 to -105 HU, to -105 HU, IQR -110 to -100 HU, p = 0.014), whereas it did not change in controls (p = 0.477). VAT density did not vary in either BC patients (p = 0.911) or controls (p = 0.627). Conclusions EAT density appears to be influenced by anthracycline treatment for BC, well known for its cardiotoxicity, shifting towards lower values indicative of a less active metabolism.

Evaluating Right Ventricular Function To Reveal Cancer Therapy Cardiotoxicity

Advances in cancer treatment resulted in augmented patient survival rate. However, anticancer therapy often causes heart damage in the form of a progressive systolic heart failure. Echocardiographic parameters of left ventricular function were conventionally used to detect early manifestations of cancer therapy cardiotoxicity. Improved diagnosing of the right ventricle condition revealed that it is negatively affected by chemotherapy as frequently as the left ventricle, and sometimes even earlier than the latter. Hence, currently, the right ventricle function and mechanics assessment techniques are actively developed for the chemotherapy cardiotoxicity diagnostic, primarily employing 3D echocardiography and speckle tracking analysis. The presented review provides relevant information on the matter and highlights insufficiently developed issues and fields of further research.

Corrected QT prolongation among chemotherapy: Treated patients, a study of a Romanian center.

e24053 Background: Chemotherapy cardiotoxicity sometimes occurs as QTc prolongation, which may lead to ventricular arrhythmia. We assessed incidence of QTc prolongation among chemotherapy-treated patients. Methods: We enrolled 396 consecutive patients receiving chemotherapy in the Oncology Institute of Cluj-Napoca, Romania. 870 ECGs were performed at baseline and every 2 months, for 5 assessments, during 2016. Results: Most patients were diagnosed with gastro-intestinal tumors and received regimens containing more than one drug. Maximum QTc was recorded after 4 months, when we also found the maximum incidence of increased QTc (>470msec), of 3,73% and of increased ΔQTc (>60msec), of 4%. Female gender was associated with a higher baseline QTc=421 msec, ± 26,9 (p=0.02). No particular chemotherapy regimen was proved to significantly increase QTc. Age was associated with higher QTc and is also an independent variable predicting QTc prolongation (for QTc >480msec, p=0.02), as well as increase of ΔQTc (p<0.001). The number of prior chemotherapy lines correlates with baseline QTc (p<0.0001), with QTc prolongation after 2 months (p=0.01) and predicts higher ΔQTc after 2 months (p=0.01), although within normal range. There was no additive effect during all the 5 assessments. Conclusions: Our results confirm QTc prolongation with chemotherapy and a special attention should be paid to previously treated patients and to elderly patients. Key words: chemotherapy, cardiotoxicity, QTc prolongation.

High Sensitive Troponin I and Extended Range C-Reactive Protein as Markers to Predict Cardiotoxicity in Locally Advanced Breast Cancer with Neoadjuvant CAF (Cyclophoshpamide, Adriamycin/Doxorubicin, 5Fluorouracil) Therapy

The limitation of echocardiography to measure chemotherapy cardiotoxicity at left locally advanced breast cancer with large ulcer is still serious problem. HsTnI and erCRP are biomarkers to detect cardiotoxicity that are cheap, easy to examine and available at Dr.Soetomo Hospital Surabaya. This study was to compare HsTnI, erCRP and echocardiography as cardiotoxicity predictors in locally advanced breast cancer with neoadjuvant CAF therapy. This study used one group pretest and posttest design among 23 locally advanced breast cancer patients. All patients underwent echocardiography, HsTnI, and erCRP examinations before and after 3 times chemotherapy and compared. The average age was 49.78±8.7. Statistically significant decrease in LVEF was found after treatment (67.98%±4.06 and 64.07%±3.53, p=0.000). HsTnI was significantly increased after treatment (0.007 µg/mL±0.004 and 0.043 µg/mL±0.051 p=0.000). erCRP was significantly decreased after treatment (1.043mg/dL±0.913 and 0.573mg/dL±0.444 p=0.044). Decreased LVEF and increased HsTnI was compared by its cardiotoxic cut-off. HsTnI was significantly better and faster to detect cardiotoxicity (0.033±0.051 p=0.002). In conclusion, strong correlation is present in the detection of cardiotoxicity between HsTnI and LVEF. HsTnI is faster than echocardiography, and could be alternative diagnostic to detect early cardiotoxicity.

The Role of Endothelial Dysfunction in the Development of Cardiotoxic Action of Cytostatics in Patients with Lymphoproliferative Diseases

Understanding mechanisms of chemotherapy cardiotoxicity is an important problem due to the lack of clear understanding of its occurrence. Development of endothelial dysfunction is considered to be one of possible ways in implementation of these side effects. The analysis of endothelin-1 and e-selectin levels in 26 patients with lymphoproliferative diseases before and after the completion of the treatment program was been performed. The results of the study showed normal values of E-selectin level and increased level of endothelin-1 in the whole group of patients before treatment. After completion of chemotherapy program, in the whole group, there was a decrease of these two markers. However, values of level of endothelin-1 with vasoconstrictor effect remained high even after the end of therapy. It is imp ortant that at detailed analysis the dynamics of investigated markers in patients of older age group (median age 64 years) was associated with worsening of endothelial dysfunction.