Long-term heart function after adjuvant epirubicin chemotherapy for breast cancer.

BACKGROUND: Newer studies raise concern that adjuvant anthracycline treatment for breast cancer (BC) causes long-term heart damage. We aimed to examine whether heart failure or impairment could be demonstrated several years after low-dose epirubicin-based adjuvant treatment. MATERIAL AND METHODS: The study-population was a historical cohort comprising 980 women who were randomized to receive one of two adjuvant regimens for treatment for BC: 7-9 cycles of cyclophosphamide-epirubicin-5-fluorouracil [CEF (600 + 60 + 600 mg/m(2))] or cyclophosphamide-methotrexate-5- fluorouracil [CMF (600 + 40 + 600 mg/m(2))]. We collected information in national registries of death and diagnoses and a sample of 77 survivors was examined with tissue-Doppler imaging (TDI), echocardiography, radionuclide ventriculography and N-terminal-pro-B-type-natriuretic peptide (NT-proBNP), an established marker for heart failure. RESULTS AND CONCLUSION: Median follow-up was 12 years (39 days-20 years). Fifty-one percent had died. Incidence of CHF was 2.6/1000/year and equal in the treatment groups. In the sample, individuals who had received CEF showed no cardiac impairment when compared to individuals who received CMF. NT-proBNP-levels were within normal limits but higher in the CEF-group than in the CMF-group (confidence limits 105-226%, p = 0.03). Results of our study seem reassuring regarding the long-term risk of cardiotoxicity following low-dose adjuvant epirubicin treatment. However, larger, longitudinal studies are needed to establish the clinical implications.

Left ventricular assist device as bridge to recovery for anthracycline-induced terminal heart failure.

Anthracycline treatments are hampered by dose-related cardiotoxicity, frequently leading to heart failure (HF) with a very poor prognosis. The authors report a case of a 19-year-old man developing HF after anthracycline treatment for Ewing sarcoma. Despite medical treatment, his condition deteriorated to terminal HF, leading to implantation of a mechanical left ventricular assist device (LVAD). His heart function recovered, allowing explantation of the device 14 months after implantation. Heart transplantation is often contraindicated in the first years after treatment for cancers, and LVAD as "bridge to recovery" may be warranted in similar patients.

Tissue-Doppler assessment of cardiac left ventricular function during short-term adjuvant epirubicin therapy for breast cancer.

BACKGROUND: It has been hypothesized that the extent of acute anthracycline-induced cardiotoxicity reflects the risk for late development of heart failure. The aim of this study was to examine if short-term changes in cardiac function can be detected even after low-dose adjuvant epirubicin therapy for breast cancer when using Doppler tissue imaging of longitudinal left ventricular function. METHODS: Eighty consecutive women in good cardiopulmonary health scheduled to undergo adjuvant treatment for breast cancer were included. They were examined using echocardiography and Doppler tissue imaging before and after three treatment series of epirubicin (mean cumulative dose, 273.7 ± 46.6 mg/m(2); median time interval, 9 weeks; range, 47-113 days). RESULTS: Apart from a marginal reduction in E/A ratio, none of the conventional Doppler echocardiographic or Doppler tissue imaging indices of systolic and diastolic function were affected during epirubicin treatment. CONCLUSIONS: In contrast to several previous studies using tissue Doppler and conventional echocardiography, this study did not document relevant short-term effects of low-dose epirubicin treatment on heart function.

Systolic versus diastolic cardiac function variables during epirubicin treatment for breast cancer.

Anthracyclines are important in the treatment of numerous malignant diseases but the use is limited by a risk of heart failure (CHF). LVEF (left ventricular ejection fraction) measurements by radionuclide ventriculography with multiple gated acquisition (MUGA) is often used for cardiac monitoring. However, diastolic variables have been proposed as sensitive supplements. It was hypothesized that a change in diastolic filling variables measured by MUGA could identify individuals after epirubicin treatment (ET) in risk of developing heart failure. A retrospective analysis of registered raw data. Individuals completing high-dose ET for breast cancer were selected from a 2-year period. All had MUGA-scans performed prior to and after ET and were observed clinically for late development of CHF. Eleven of 34 individuals developed CHF. A significant LVEF-reduction was recorded after ET with only minor changes in diastolic parameters. Development of CHF was related to dose, entry-blood pressure and inversely to post-epirubicin LVEF. Risk of CHF was high if LVEF <50% (Hazard ratio 3.31). Epirubicin induces considerable decrease in LVEF and a high risk of CHF. The risk of CHF is significantly higher if LVEF is reduced after ET. Diastolic MUGA-variables seem to add little information to conventional measurements of LVEF.

Anthracycline-induced chronic cardiotoxicity and heart failure.

Anthracyclines are effective drugs used in a wide range of malignant diseases. The drugs have frequent, serious adverse effects including cardiotoxicity and resulting heart failure. Systematic reviews, meta-analyses and other relevant studies were identified using the Cochrane and the Medline databases. Chronic cardiotoxicity and heart failure may complicate anthracycline treatment often months to years after treatment has ended. Risk factors including diverse cardiac diseases increase the risk of chronic cardiotoxicity. Screening for impairment of left ventricular function with echocardiography or radionuclide ventriculography is recommended. Search for new sensitive methods has been prompted to predict development of heart failure at an early stage enabling to modify the chemotherapeutic regimen, to include cardiac protectants or to initiate treatment.