Clinical and echocardiographic characteristics of early cardiotoxicity in patients with breast cancer treated with chemotherapy
Keywords:
cancer, cardiotoxicity, chemotherapy, cardio-oncology.Abstract
Introduction: Cardiovascular complications are the main cause of mortality in cancer survivors.Objectives: To identify the clinical and echocardiographic characteristics of cardiotoxicity in patients with breast cancer treated with chemotherapy.
Methods: Cross-sectional study in 451 patients with breast cancer. Each patient underwent an interrogation, physical examination, hemochemistry, electrocardiogram, and echocardiogram (the latter, before chemotherapy, at 3, 6, and 12 months. Frequencies were obtained for qualitative variables and proportions were compared using the z statistic; for the quantitative variables, the mean, standard deviation, minimum and maximum value were estimated. Mean differences were calculated with Student's t-test, after determining the distribution. For all analyses, the level of significance was set at p< 0.05.
Results: The frequency of cardiotoxicity was 15.9 %. The mean age was 60.1 ± 12.6 years. Arterial hypertension was identified in 60.1 % of the patients, left ventricular hypertrophy in 48.6 %, and hypertensive heart disease in 35.7 %. Left ventricular ejection fraction and left atrial diameter showed greater differences (p= 0.000 in both cases) after treatment.
Conclusions: The characteristics of patients with cardiotoxicity are: age over 60 years, smoking, reduced glomerular filtration rate, hypertensive heart disease, prolongation of the Q-Tc interval, increased diameter of the left atrium, diastolic dysfunction and depression left ventricular ejection fraction.
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References
1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65(1):5-29. DOI:10.3322/caac.21254
2. Gavila J, Seguí MA, Calvo L, López T, Alonso J, Farto M, Sánchez de la Rosa R. Evaluation and management of chemotherapy-induced cardiotoxicity in breast cancer: a Delphi study. Clin Transl Oncol. 2017; 19:91–104. DOI: 10.1007/s12094-016-1508-y
3. Johnson CB, Davis MK, Law A, Sulpher J. Shared Risk Factors for Cardiovascular Disease and Cancer: Implications for Preventive Health and Clinical Care in Oncology Patients. Can J Cardiol. 2016; 32(7):900-907. DOI: 10.1016/j.cjca.2016.04.008
4. Ministerio de Salud Pública. Anuario Estadístico de Cuba 2019. La Habana: Minsap; 2020. [acceso: 08/03/2021]. Disponible en: https://files.sld.cu/bvscuba/files/2020/05/Anuario-Electr%C3%B3nico-Espa%C3%B1ol-2019-ed-2020.pdf
5. Agunbiade TA, Zaghlol RY, Barac A. Heart Failure in Relation to Anthracyclines and Other Chemotherapies. Methodist Debakey Cardiovasc J. 2019; 15(4):243-9. DOI: 10.14797/mdcj-15-4-243
6. Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol. 2020; 50(3):225-29. DOI: 10.1093/jjco/hyz213
7. Hameau R, Gabrielli L, Garrido M, Guzmán AM, Retamal I, Vacarezza MJ, et al. Cardiotoxicidad inducida por tratamientos oncológicos. Fundamentos para la implementación de equipos de Cardio-Oncología. Rev. méd. Chile. 2018; 146(1): 68-77. DOI: 10.4067/s0034-98872018000100068
8. Fardales-Rodríguez R, Rodríguez-Ramos M, Castellanos-Gallo L. Cardio-oncología, una ciencia necesaria. Revista Cubana de Cardiología y Cirugía Cardiovascular. 2020 [acceso:19/01/2022]; 27(1):e1098. Disponible en: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/1098
9. Rodríguez Ramos, M. Estratificación del riesgo de cardiotoxicidad inducida por quimioterapia. Cor Salud. 2018 [acceso: 11/07/ 2021]; 10(4):341-2. Disponible en:http://www.revcorsalud.sld.cu/index.php/cors/article/view/392/797
10. Serrano C, Cortés J, De Mattos-Arruda L, Bellet M, Gómez P, Saura C, et al. Trastuzumab-related cardiotoxicity in the elderly: a role for cardiovascular risk factors. Ann Oncol. 2019; 30(7):1178. DOI:10.1093/annonc/mdy534
11. Parent S, Pituskin E, Paterson DI. The Cardio-oncology Program: A multidisciplinary approach to the care of cancer patients with cardiovascular disease. Can J Cardiol. 2016; 32(7): 847-851. DOI: 10.1016/j.cjca.2016.04.014
12. Zaheed M, Wilcken N, Willson ML, O'Connell DL, Goodwin A. Sequencing of anthracyclines and taxanes in neoadjuvant and adjuvant therapy for early breast cancer. Cochrane Database of Systematic Reviews. 2019; (2):CD012873. DOI: 10.1002/14651858.CD012873.pub2
13. Morales Yera RA, Sierra Pérez L, Triana Díaz A. Cardiotoxicidad inducida por quimioterapia. CorSalud. 2018 [acceso: 19/01/2022]; 10(1): 68-77 Disponible en: http://www.revcorsalud.sld.cu/index.php/cors/article/view/295/635
14. Fernández-González EM, Figueroa-Oliva DA. Tabaquismo y su relación con las enfermedades cardiovasculares. Rev haban cienc méd. 2018 [acceso: 05/05/2022]; 17(2): 225-35. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2018000200008&lng=es
15. Levey A, Stevens L, Schmid CH, Lucy Zhang Y, Castro A, Feldman H, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. DOI:10.7326/0003-4819-150-9-200905050-00006
16. Rubio M, Moreno C, Cabrerizo L. Guías para el tratamiento de las dislipemias en el adulto: Adult Treatment Panel III (ATP-III). Endocrinología y Nutrición. 2004; 51(5):254–65. DOI: 10.1016/S1575-0922(04)74614-8
17. Bazett HC. An Analysis of the time-relations of electrocardiograms. Annals of Noninvasive Electrocardiology. 2006; 2(2): 177-194. DOI: 10.1111/1.1542-474x.1997.tb00325.x
18. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57(6): 450-8. DOI: 10.1016/0002-9149(86)90771-x
19. Cairo-Sáez G, Batista-Hernández N, Peñate-Tamayo F, de-la-Torre-Santos A. Evaluación cardiaca de pacientes con cáncer de mama tratadas con antraciclinas. Revista Cubana de Cardiología y Cirugía Cardiovascular. 2017 [acceso: 19/01/2022]; 23(1): 266-71: [aprox. 5 p.]. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/679
20. Mata Caballero R. Incidencia y predictores de cardiotoxicidad a largo plazo en pacientes con cáncer de mama tratados con antraciclinas [Tesis doctoral]. Madrid: Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina; 2020. [acceso: 14/12/2021]. Disponible en: http://hdl.handle.net/10486/692393
21. Menna P, Salvatorelli E. Primary Prevention Strategies for Anthracycline Cardiotoxicity: A Brief Overview. Chemotherapy. 2017; 62(3):159-68. DOI: 10.1159/000455823
22. Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Dendulur N, et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017; 35(8):893-911. DOI: 10.1200/JCO.2016.70.5400
23. Zamora P. El tratamiento oncológico triplica el riesgo de complicaciones cardiovasculares. Madrid: Sociedad Española de Cardiología; 2015 [acceso: 11/09/2021]. Disponible en:https://secardiologia.es/comunicacion/notas-de-prensa/notas-de-prensa-sec/6502-tratamiento-oncologico-triplica-riesgo-de-complicaciones-cardiovasculares
24. Swain SM, Ewer MS, Viale G, Delaloge S, Ferrero JM, Verrill M, et al. Pertuzumab, trastuzumab, and standard anthracycline and taxane based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label and multicenter, multinational cardiac safety study. Ann Oncol. 2018; 29(3):646-53. DOI: 10.1093/annonc/mdx773
25. Cardinale D, Ciceri F, Latini R, Franzosi MG. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International Cardio Oncology Society-one trial. Eur J Cancer. 2018; 94:126-137. DOI: 10.1016/j.ejca.2018.02.005
26. Jacob S, Pathak A, Franck D, Latorzeff I, Jimenez G, Fondard O, et al. Early detection and prediction of cardiotoxicity after radiation therapy for breast cancer: the BACCARAT prospective cohort study. Radiat Oncol. 2016; 11:54. DOI: 10.1186/s13014-016-0627-5
28. Doan Ngo, Untaru R, Chen D, May A, Collins NJ, Leitch J, et al. Suboptimal Use of Cardioprotective Medications in Patients With a History of Cáncer. J Am Coll Cardiol Cardio Onc. 2020; 2(2):312-15. DOI: 10.1016/j.jaccao.2020.05.010
29. Matos E, Jug B, Blagus R, Zakotnik B. A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients. Arq Bras Cardiol. 2016; 107(1):40-47. DOI: 10.5935/abc.20160084
30. López-Sendín J, Álvarez-Ortega C, Zamora-Auñon P, Buño-Soto A, Lyon AR, Farmakis D, et al. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry. Eur Heart J. 2020; 41(18):1720-9. DOI: 10.1093/eurheartj/ehaa006
2. Gavila J, Seguí MA, Calvo L, López T, Alonso J, Farto M, Sánchez de la Rosa R. Evaluation and management of chemotherapy-induced cardiotoxicity in breast cancer: a Delphi study. Clin Transl Oncol. 2017; 19:91–104. DOI: 10.1007/s12094-016-1508-y
3. Johnson CB, Davis MK, Law A, Sulpher J. Shared Risk Factors for Cardiovascular Disease and Cancer: Implications for Preventive Health and Clinical Care in Oncology Patients. Can J Cardiol. 2016; 32(7):900-907. DOI: 10.1016/j.cjca.2016.04.008
4. Ministerio de Salud Pública. Anuario Estadístico de Cuba 2019. La Habana: Minsap; 2020. [acceso: 08/03/2021]. Disponible en: https://files.sld.cu/bvscuba/files/2020/05/Anuario-Electr%C3%B3nico-Espa%C3%B1ol-2019-ed-2020.pdf
5. Agunbiade TA, Zaghlol RY, Barac A. Heart Failure in Relation to Anthracyclines and Other Chemotherapies. Methodist Debakey Cardiovasc J. 2019; 15(4):243-9. DOI: 10.14797/mdcj-15-4-243
6. Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol. 2020; 50(3):225-29. DOI: 10.1093/jjco/hyz213
7. Hameau R, Gabrielli L, Garrido M, Guzmán AM, Retamal I, Vacarezza MJ, et al. Cardiotoxicidad inducida por tratamientos oncológicos. Fundamentos para la implementación de equipos de Cardio-Oncología. Rev. méd. Chile. 2018; 146(1): 68-77. DOI: 10.4067/s0034-98872018000100068
8. Fardales-Rodríguez R, Rodríguez-Ramos M, Castellanos-Gallo L. Cardio-oncología, una ciencia necesaria. Revista Cubana de Cardiología y Cirugía Cardiovascular. 2020 [acceso:19/01/2022]; 27(1):e1098. Disponible en: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/1098
9. Rodríguez Ramos, M. Estratificación del riesgo de cardiotoxicidad inducida por quimioterapia. Cor Salud. 2018 [acceso: 11/07/ 2021]; 10(4):341-2. Disponible en:http://www.revcorsalud.sld.cu/index.php/cors/article/view/392/797
10. Serrano C, Cortés J, De Mattos-Arruda L, Bellet M, Gómez P, Saura C, et al. Trastuzumab-related cardiotoxicity in the elderly: a role for cardiovascular risk factors. Ann Oncol. 2019; 30(7):1178. DOI:10.1093/annonc/mdy534
11. Parent S, Pituskin E, Paterson DI. The Cardio-oncology Program: A multidisciplinary approach to the care of cancer patients with cardiovascular disease. Can J Cardiol. 2016; 32(7): 847-851. DOI: 10.1016/j.cjca.2016.04.014
12. Zaheed M, Wilcken N, Willson ML, O'Connell DL, Goodwin A. Sequencing of anthracyclines and taxanes in neoadjuvant and adjuvant therapy for early breast cancer. Cochrane Database of Systematic Reviews. 2019; (2):CD012873. DOI: 10.1002/14651858.CD012873.pub2
13. Morales Yera RA, Sierra Pérez L, Triana Díaz A. Cardiotoxicidad inducida por quimioterapia. CorSalud. 2018 [acceso: 19/01/2022]; 10(1): 68-77 Disponible en: http://www.revcorsalud.sld.cu/index.php/cors/article/view/295/635
14. Fernández-González EM, Figueroa-Oliva DA. Tabaquismo y su relación con las enfermedades cardiovasculares. Rev haban cienc méd. 2018 [acceso: 05/05/2022]; 17(2): 225-35. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2018000200008&lng=es
15. Levey A, Stevens L, Schmid CH, Lucy Zhang Y, Castro A, Feldman H, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. DOI:10.7326/0003-4819-150-9-200905050-00006
16. Rubio M, Moreno C, Cabrerizo L. Guías para el tratamiento de las dislipemias en el adulto: Adult Treatment Panel III (ATP-III). Endocrinología y Nutrición. 2004; 51(5):254–65. DOI: 10.1016/S1575-0922(04)74614-8
17. Bazett HC. An Analysis of the time-relations of electrocardiograms. Annals of Noninvasive Electrocardiology. 2006; 2(2): 177-194. DOI: 10.1111/1.1542-474x.1997.tb00325.x
18. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57(6): 450-8. DOI: 10.1016/0002-9149(86)90771-x
19. Cairo-Sáez G, Batista-Hernández N, Peñate-Tamayo F, de-la-Torre-Santos A. Evaluación cardiaca de pacientes con cáncer de mama tratadas con antraciclinas. Revista Cubana de Cardiología y Cirugía Cardiovascular. 2017 [acceso: 19/01/2022]; 23(1): 266-71: [aprox. 5 p.]. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/679
20. Mata Caballero R. Incidencia y predictores de cardiotoxicidad a largo plazo en pacientes con cáncer de mama tratados con antraciclinas [Tesis doctoral]. Madrid: Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina; 2020. [acceso: 14/12/2021]. Disponible en: http://hdl.handle.net/10486/692393
21. Menna P, Salvatorelli E. Primary Prevention Strategies for Anthracycline Cardiotoxicity: A Brief Overview. Chemotherapy. 2017; 62(3):159-68. DOI: 10.1159/000455823
22. Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Dendulur N, et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017; 35(8):893-911. DOI: 10.1200/JCO.2016.70.5400
23. Zamora P. El tratamiento oncológico triplica el riesgo de complicaciones cardiovasculares. Madrid: Sociedad Española de Cardiología; 2015 [acceso: 11/09/2021]. Disponible en:https://secardiologia.es/comunicacion/notas-de-prensa/notas-de-prensa-sec/6502-tratamiento-oncologico-triplica-riesgo-de-complicaciones-cardiovasculares
24. Swain SM, Ewer MS, Viale G, Delaloge S, Ferrero JM, Verrill M, et al. Pertuzumab, trastuzumab, and standard anthracycline and taxane based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label and multicenter, multinational cardiac safety study. Ann Oncol. 2018; 29(3):646-53. DOI: 10.1093/annonc/mdx773
25. Cardinale D, Ciceri F, Latini R, Franzosi MG. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International Cardio Oncology Society-one trial. Eur J Cancer. 2018; 94:126-137. DOI: 10.1016/j.ejca.2018.02.005
26. Jacob S, Pathak A, Franck D, Latorzeff I, Jimenez G, Fondard O, et al. Early detection and prediction of cardiotoxicity after radiation therapy for breast cancer: the BACCARAT prospective cohort study. Radiat Oncol. 2016; 11:54. DOI: 10.1186/s13014-016-0627-5
28. Doan Ngo, Untaru R, Chen D, May A, Collins NJ, Leitch J, et al. Suboptimal Use of Cardioprotective Medications in Patients With a History of Cáncer. J Am Coll Cardiol Cardio Onc. 2020; 2(2):312-15. DOI: 10.1016/j.jaccao.2020.05.010
29. Matos E, Jug B, Blagus R, Zakotnik B. A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients. Arq Bras Cardiol. 2016; 107(1):40-47. DOI: 10.5935/abc.20160084
30. López-Sendín J, Álvarez-Ortega C, Zamora-Auñon P, Buño-Soto A, Lyon AR, Farmakis D, et al. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry. Eur Heart J. 2020; 41(18):1720-9. DOI: 10.1093/eurheartj/ehaa006
Published
2022-08-27
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Pérez Domínguez JA, Rodríguez Peña MM, Aguilar Almaguer OS, Rodríguez Reyes M, Leblanch Pérez L, Pérez Oliva A. Clinical and echocardiographic characteristics of early cardiotoxicity in patients with breast cancer treated with chemotherapy. Rev Cubana Med Milit [Internet]. 2022 Aug. 27 [cited 2025 Mar. 31];51(3):e02201931. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1931
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