ABSTRACT
OBJECTIVE: The aim of the present study was to evaluate possible variations in cardiac hemodynamic parameters related to the natural changes of ovarian estrogen production. METHODS: Forty postmenopausal women aged 52.7 +/- 4.6 years, randomized into two groups (20 patients in each group) according to the administration (group A) or not (group B) of estroprogestin replacement therapy (ERT), were examined using thoracic electrical bioimpedence. RESULTS: After 6 months of therapy, we observed the following: (1) the mean end-diastolic index was significantly higher in group A than in group B (70.27 and 57.13 mL/m2, respectively) (p < 0.05); (2) the mean acceleration index, indicator of heart contractility, and the mean cardiac index rate, indicators of cardiac performance, were significantly higher in group A than in group B (mean, 1.35 vs. 0.76 s [p < 0.01] and mean, 3.22 vs. 2.34 L/min/m2 [p < 0.05], respectively); and (3) the patients treated with ERT showed systemic vascular resistance index values significantly lower than the controls (mean, 2280 vs. 3150 fOhm/m2 [p < 0.01]), achieving standard levels after 6 months of therapy. Furthermore, the acceleration index showed a significant increase, within group A, between the third and sixth month of ERT (0.91 vs. 1.35 s [p < 0.05]). CONCLUSIONS: Our findings suggest that postmenopausal women treated with a 6-month course of ERT have significantly improved end-diastolic index, heart contractility index, cardiac index, and systemic vascular resistance, whereas 3 months of ERT does not seem to induce the same effects. In our study, thoracic electrical bioimpedence was shown to be a sensitive and specific method of analysis with a very low cost of administration.
Subject(s)
Cardiovascular Physiological Phenomena/drug effects , Estrogen Replacement Therapy , Muscle Contraction/drug effects , Postmenopause/drug effects , Adult , Analysis of Variance , Cardiac Output/drug effects , Drug Combinations , Estrogens/therapeutic use , Female , Hemodynamics/drug effects , Humans , Middle Aged , Muscle Contraction/physiology , Postmenopause/physiology , Progestins/therapeutic use , Statistics, Nonparametric , Vascular Resistance/drug effectsABSTRACT
Anthracyclines are the most frequent cause of iatrogenic congestive heart failure ranging from acute reversible minor, irreversible reduction in the left ventricular ejection fraction and death despite preventive measures. Sensitive methods are needed to detect earliest preclinical cardiotoxicity along with the development of new protective agents. Thirty breast cancer patients were randomly treated with q 21 120 mg/m2 Epirubicin (EPI) x 3, alone (10 patients), or + ICRF-187 (1000 mg/m2) (10 patients) or + C0Q10 (50 mg/day) (10 patients) and monitored by Thoracic Electrical Bioimpedance (TEB) cardiography before (T0) and at the end of chemotherapy (T1), then at 1, 3, 6 months of follow up (F1, F2, F3). a) The group treated with EPI alone showed, between F1-F2, a significant (p < 0.05) decrease in Stroke Index (S1). Acceleration Index (ACI) and a significant (p < 0.05) increase in Systemic Vascular Resistance Index (SVRI), while between F2 and F3 it showed a significant (p < 0.05) recovery in S1 and ACI. b) The group treated with EPI + ICRF-187 showed, between F1 and F2 a significant decrease in S1 and ACI (p < 0.05, p < 0.01 respectively) and a significant (p < 0.05) increase in SVRI: between F2-F3 ACI had a significant (p < 0.05) recovery: c) The group treated with EPI +C0Q10 showed no modification in Sl, ACI, and SVRI during the study. The ejection Fraction (EF) remained unchanged during the study in all the groups. C0Q10 seems to prevent early decreases in cardiac performance and contractiling, thus avoiding an SVRI increase, while ICRF-187 did not. Since ICRF-187 acts by binding iron, we deem that the earliest cardiac involvement, may occur before iron overload; therefore the role of ICRF-187 and C0Q10 in acute or chronic heart toxicity was correlated with high-dose anthracycline and needs to be further investigated.
