Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy

Paul W. Stoodley, David A.B. Richards, Anita Boyd, Rina Hui, Paul R. Harnett, Steven R. Meikle, Jillian L. Clarke, Liza Thomas
2012 European Heart Journal-Cardiovascular Imaging  
Aims The benefits from anthracycline chemotherapy are undermined by potentially life-threatening cardiotoxicity. Transthoracic echocardiography is the most commonly used method for monitoring cardiotoxicity, and centres on the measurement of left ventricular systolic function. The aim of this study was to utilize two-dimensional speckle tracking echocardiography (2DSTE) at baseline and immediately after anthracycline chemotherapy to investigate whether patients with significant changes in
more » ... ic function after anthracycline therapy would also develop alterations in diastolic parameters. Methods and results Fifty-two women with histologically confirmed breast cancer were prospectively recruited. Echocardiograms were performed 1 week prior to and 1 week following chemotherapy (always before adjuvant trastuzumab or thoracic radiotherapy). Conventional Doppler, tissue velocity imaging (TVI), and 2DSTE were used to measure diastolic function. 2DSTE measurements included longitudinal diastolic strain, early (E-Sr), and late (A-Sr) myocardial strain rate. 2DSTE and left ventricular ejection fraction (LVEF) were used to measure longitudinal systolic function. Altered LV diastolic function (including E-Sr) was observed in the entire cohort after chemotherapy, with a differential reduction in participants with a post therapy LVEF ,55%. Pre-chemotherapy systolic strain was found to predict reduced E-Sr post therapy (P ¼ 0.04). Univariate predictors of E-Sr were LVEF post therapy (P ¼ 0.049) and systolic strain posttherapy (P ¼ 0.01). In a multivariate analysis, systolic strain after chemotherapy was the strongest independent predictor (P ¼ 0.001). Conclusion Altered LV diastolic function was observed immediately after the administration of therapeutic doses of anthracycline chemotherapy. Furthermore, our analysis indicates that the changes in diastolic function are associated with reduced systolic function. --- Keywords Diastolic function † Two-dimensional speckle tracking echocardiography (2DSTE): anthracyclines * Corresponding author. Tel: +61 02 9687 0866; fax: +61 02 9687 0422.
doi:10.1093/ehjci/jes139 pmid:22782955 fatcat:4hding2pjbf4hksz6gndvkkm3i