Left ventricular diastolic performance in breast cancer survivors treated with anthracyclines

The aim of our study was to evaluate left ventricular diastolic and systolic performance in women diagnosed with breast cancer and treated with low doses of anthracyclines (epirubicin).

Thirty-four female patients with breast cancer treated with epirubicin up to 450 mg/m2 (study group), and a matched control group of 34 women diagnosed with breast tumours, who had not started chemotherapy, were assessed by echocardiography. Left ventricular diastolic function was evaluated by measuring Doppler transmitral flow: the maximal velocity of the E and A waves (rapid filling and atrial filling), the Emax/Amax ratio, the pressure half time (PHT) of the E wave and the isovolumic relaxation time (IVRT). The left ventricular ejection fraction was calculated to assess systolic performance. We documented a significant decrease of Emax, whereas the A wave was significantly increased in the study group compared to the control group. The mitral E/A ratio was below 1 in the study group. Prolonged PHT and IVRT were also detected in the epirubicin-treated group when compared with the control group. Left ventricular systolic performance was not significantly altered in the study group in comparison with the control group. Although the ejection fraction was lower in the study group the difference did not reach statistical significance.

Our study certified impaired left ventricular diastolic performance in patients with breast cancer treated with low total doses of epirubicin (< or = 450 mg/m2). We concluded that diastolic impairment is due to poor left ventricular compliance being an early marker of epirubicin cardiotoxicity that precedes systolic function alterations.