ABSTRACT
AIMS: In the present study, we compare different echocardiographic cardiac dyssynchrony parameters, both of intraventricular and interventricular dyssynchrony, in order to predict response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS: In a population of 77 heart failure patients scheduled for CRT, we measured the interventricular mechanical delay (IVMD) and we analyzed six different parameters of intraventricular dyssynchony: the tissue Doppler imaging (TDI) septum-lateral wall delay, the systolic dyssynchrony index; the three-dimensional SD of the time to reach minimum systolic volume for 16 left ventricular segments (3D-SDI); the speckle-tracking radial, circumferential and longitudinal dyssynchrony. At 6 months of follow-up, 61 (79%) patients were responders (≤15% in left ventricular end-systolic volume). On baseline analysis, 3D-SDI, radial strain, longitudinal strain and circumferential strain and IVMD were significantly higher in responder group (10.8â±â3.9 vs. 7.6â±â1.8% for 3D-SDI; Pâ=â0.003; 212â±â91 vs. 125â±â36âms for radial strain, Pâ=â0.0003; 185â±â83 vs. 134â±â53âms for longitudinal strain, Pâ=â0.02; 190â±â80 vs. 130â±â54âms for circumferential strain, Pâ=â0.006; 45â±â21 vs. 30â±â20âms for IVMD; Pâ=â0.01). On univariate and multivariate analysis, only IVMD was significantly associated with a complete echocardiographic response to CRT. 3D-SDI and radial strain present the better values of sensitivity and specificity, overall if associated to an evaluation of IVMD (sensitivity 76%, specificity 88%, for 3D-SDIâ+âIVMD; sensitivity 80% and specificity 85% for radial strainâ+âIVMD). CONCLUSION: The novel parameters, such as 3D-SDI and speckle-tracking (particularly radial strain), offer better diagnostic accuracy in identifying patients who are responders to CRT. The addition of the contemporary parameter of IVMD improves the diagnostic accuracy.
Subject(s)
Cardiac Resynchronization Therapy/methods , Heart Failure/diagnostic imaging , Heart Failure/therapy , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Aged, 80 and over , Echocardiography, Doppler/methods , Echocardiography, Three-Dimensional/methods , Female , Follow-Up Studies , Heart Failure/complications , Humans , Image Interpretation, Computer-Assisted/methods , Male , Middle Aged , Predictive Value of Tests , Prognosis , Reproducibility of Results , Treatment Outcome , Ventricular Dysfunction, Left/etiologyABSTRACT
Capecitabine is an orally available fluoropyrimidine carbamate that selectively delivers fluorouracil (5-FU) to tissues expressing high levels of thymidine phosphorylase (TP) such as tumors. The drug has demonstrated efficacy in metastatic breast cancer, colorectal, and pancreatic cancer. Although these are considered safe drugs, a growing body of literature reports adverse cardiac effects. Clinical trials indicate that capecitabine has a cardiac toxicity similar to that of infused fluoropyrimidines such as 5-FU. Here, we review cardiotoxicity in the use of fluoropyrimidines, with particular attention toward capecitabine. We also describe a severe, reversible cardiac event that occurred in a 39-year-old woman, with no cardiac risk factors, treated with capecitabine for advanced breast cancer. This review and our experience confirm that fluoropyrimidine cardiotoxicity is an infrequent but documented side effect. Oncology patients under treatment should be closely observed and monitored for cardiac symptoms with particular attention in case of signs or symptoms of cardiovascular complications. The implementation of cardio-oncology interdisciplinary teams should, in the future, reduce the impact of cancer treatment-associated cardiotoxicity syndromes.
