Early diagnosis of cardiotoxicity by anticancer therapy with pulsed wave tissue doppler imaging: detection of the cut-off value

of myocardial systolic velocity

AUTHORS: F. Maramao , Y. Conde , I. Sperduti , F. Rulli . 1 1 2 ( ) U.O. Cardiology, ( )Biostatistics Unit; Regina Elena, National Cancer Institute - Rome, Italy. ( ) Cardiology ASL RM/B, Rome Italy.
1 2 1 1

Purpose
Anticancer therapy can lead to hypokinetic cardiomyopathy that may progress to severe heart failure.The conventional tools currently being used for the diagnosis of cardiotoxicity, have a low diagnostic accuracy and a low predictive power. The purpose of this study is to find out the cut-off value of myocardial systolic velocity (Sm) as part of a cost-effective model for early diagnosis of cardiotoxicity by anticancer therapy.

Methods
From July 2009 to April 2012 have been studied 168 women with breast cancer, average age 52.6 12.9 years, divided into 3 groups (gr). Gr.1: (60) no anticancer therapy; gr. 2: (89) anticancer therapy with anthracycline (AN) or AN and trastuzumab (T), without conventional echocardiographic signs of cardiotoxicity, gr. 3: (19), with conventional echocardiographic signs of cardiotoxicity by AN or AN and T. Have been excluded the patients with congenital or acquired heart diseases. All patients underwent to conventional echocardiographic examination and, to pulsed wave tissue Doppler Imaging (PW-TDI) at the level of the septal mitral annulus, to detect, respectively, the left ventricular ejection fraction (LVEF, 2D) and the Sm. Statistical Analysis: univariate analisys of variance, Bonferroni test and receiver operating characteristic curves (ROC).

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(%)

(Cm/sec)

p<0.0001

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Results
The mean of Sm was, in gr. 1 (7.5 1.6 SD), in gr. 2 (6.8 1.3 SD) and in gr. 3 (5.4 1.1 SD). A statistically significant difference (p<0.01) in Sm values, was seen between gr. 1 and 3 and gr. 2 and 3. A statistically significant difference (p<0,05) in Sm values was seen between gr. 1 and 2. The mean of LVEF was in gr. 1 (64.1 4.2 SD); in gr. 2 (63.4 4.5 SD), and in gr. 3 (52.3 8.4 SD). A statistically significant difference (p<0.01) in LVEF values was seen between gr. 1 and 3 and gr. 2 and 3. No statistically significant difference was found between gr. 1 and 2 relating the LVEF parameter. The sensitivity was 84.2 and 68.4 respectively, for the Sm and for the LVEF.
Doctor Fabio Maramao (EUD ID : 381443) Regina Elena, National Cancer Institute Cardiology - Dept. Area Critica Via Elio Chianesi 53 00144 - Rome Italy Phone : +39 0652662927 - Fax : +39 0652665368 Email : maramao@ifo.it

Conclusions
The study found that in these patients, the sensitivity of the Sm is higher than that of LVEF and the cut-off value of Sm, indicative of cardiotoxicity by anticancer therapy (AN or T) is 6 cm/s. Therefore we suggest always to measure the Sm (PW-TDI), together with the LVEF (2D), it is useful in the case of diagnostic doubt, and cost-effective for early detection of cardiotoxicity. In fact in the absence of clinical and/or conventional echocardiographic signs of cardiotoxicity, we recommend hs Troponin and NT pro-BNP measurement, only to those patients with Sm less than 6 cm/s.

Graphic by Sandro Fantusi 2013