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- Open Access
Early and late left ventricular effects of breast cancer chemotherapy: a prospective multi-centre study using advanced cardiac imaging
© Grover et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Left Ventricular Ejection Fraction
- Myocardial Dysfunction
- Global Longitudinal Strain
- Myocardial Edema
Myocardial dysfunction is a recognized toxicity of anthracycline (A) and herceptin (H) chemotherapy. Whilst there is much current focus on the incidence and magnitude of myocardial dysfunction following the A/H regimen, whether these changes are mediated by reversible or irreversible myocardial injury remains unknown . We sought to determine rates of persistent LV dysfunction at 12 months (as defined by left ventricular ejection fraction (LVEF) decrease by 10% or below lower limits of normal) following A/H and explore the mechanism of myocardial dysfunction using advance cardiac imaging.
Thirty six chemonaive patients (26 with A, 10 with H) with breast cancer, underwent serial CMR imaging (for LV volumes/EF, myocardial edema and necrosis) and advanced echocardiography for global longitudinal strain (GLS) in addition to standard measurements of LV diastolic function. All tests were conducted at baseline, 1, 3 and 12 months (21 patients). Six normal volunteers underwent the same CMR protocol. For edema imaging, short-TI inversion recovery was used in 3 short-axis views of the LV. Myocardial edema was assessed using Lake Louis criteria .
Functional changes following chemotherapy
1 month (n=33)
3 months (n=33)
12 months (n=21)
Our data suggest that the subtle functional changes in the LV myocardium early post breast cancer chemotherapy persist into 12 months in a significant number of patients. These changes are likely mediated by myocardial inflammation, and despite absence of irreversible myocardial injury, continue to 12 months post therapy. These findings warrant caution and suggest ongoing regular follow-up of patients following chemotherapy is required.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.