Abstract | BACKGROUND: PATIENTS AND METHODS: In 100 consecutive patients receiving anthracycline-based chemotherapy serial measurements of left ventricular systolic and diastolic function, Tei index (a Doppler echocardiographic parameter of global ventricular function), cardiac troponin T (cTnT) and NT-probrain natriuretic peptides (BNP) at baseline and during 1-year follow-up were performed. RESULTS: Mean ejection fraction (LVEF) significantly decreased immediately after completion of anthracycline therapy (mean dose 226.1 +/- 8.3 mg/m(2)) und further declined during follow-up (65.9 +/- 0.6% Vs. 61.6 +/- 0.7%; P < 0.001), while mean E/A ratio decreased after 6 months (P = 0.05). No patient presented with cardiac symptoms. The Tei index increased after therapy in the majority of patients (78.8%) compared with pre- therapy values indicating myocardial alteration in more patients than previously recognized. cTnT levels did not exceed the upper limit of the normal range in any patient. Seven patients had low-level elevations of cTnT. Only one of these patients developed a concomitant decrease in LVEF. Mean N-terminal-pro-BNP ( NT-proBNP) levels did not significantly change after anthracycline administration. However, in 13 patients (15.3%) a marked, transient increase of NT-proBNP was obtained after the first anthracycline cycle without cardiac dysfunction presumably due to altered cardiac loading conditions during chemotherapy. CONCLUSION: Low to moderate doses of anthracyclines resulted in subclinical myocardial alteration in more patients than so far noticed. Clinical implications of increased Tei index remain to be determined in long-term. Our results do not support that assessment of cTnT or BNP levels may safely replace serial echocardiographic evaluation of systolic and diastolic function for the monitoring of anthracycline cardiotoxicity.
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Authors | Fotiní Dodos, Teresa Halbsguth, Erland Erdmann, Uta C Hoppe |
Journal | Clinical research in cardiology : official journal of the German Cardiac Society
(Clin Res Cardiol)
Vol. 97
Issue 5
Pg. 318-26
(May 2008)
ISSN: 1861-0684 [Print] Germany |
PMID | 18193371
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Anthracyclines
- Biomarkers
- Peptide Fragments
- Protein Precursors
- Troponin T
- pro-brain natriuretic peptide (1-76)
- Natriuretic Peptide, Brain
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Topics |
- Adult
- Aged
- Anthracyclines
(adverse effects, therapeutic use)
- Biomarkers
(blood)
- Cardiomyopathies
(blood, chemically induced, physiopathology)
- Echocardiography, Doppler
- Female
- Follow-Up Studies
- Heart Ventricles
(diagnostic imaging, drug effects, physiopathology)
- Humans
- Immunoassay
- Male
- Middle Aged
- Myocardial Contraction
(drug effects)
- Natriuretic Peptide, Brain
(blood)
- Neoplasms
(drug therapy)
- Peptide Fragments
(blood)
- Prognosis
- Protein Precursors
- Time Factors
- Troponin T
(blood)
- Ventricular Function, Left
(drug effects)
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