Screening cardiotoxicity among breast cancer patients undergoing chemotherapy

Abstract

Introduction: Cardiovascular disease is the leading cause of non-cancer deaths in breast cancer patients. However, many scientists emphasized that anti-cancer medication extend the survival of patients, improve their quality of life and reduce their mortality, but on the other hand, these chemotherapies may damage heart and vessel causing cardiovascular diseases such as heart failure. Purpose: To assess the risk of cardiotoxicity among patients who are receiving chemotherapy for breast cancer treatment using echocardiography based left ventricular ejection fraction. Materials and methods: The study involved 36 participants who were diagnosed with breast cancer by biopsy and underwent between Junes to December 2019 based on the outpatient department of the Cancer Center of Mongolia. In the beginning of the study, the risk of cardiotoxicity was assessed, and at the beginning of the study (T0) and after 3 courses of chemotherapy (T1) the ultrasound diagnosis of the heart was made to determine the ejection fraction of the left ventricle. The ejection fraction differences between the two measurements were evaluated for toxicity to the heart compared to the clinical manifestation in the participants. Results: The 88.9% (n = 32) of the participants were at very high risk, 8.3% (n = 3) are at high risk and medium risk to develop cardiotoxicity was about 2.8% (n = 1). Regarding the left ventricular function, by T0 measurement, the ejection fraction was 59.5% ± 7.9, at T1 measurement, it decreased to 53.6% ± 9.5, and on average 5.9% decrease for each participant of the study. In assessing the effects of cardiotoxicity, 44.5% (n = 16) of the respondents had cardiovascular clinical manifestation and ∆LVEF declined more than 5%, while 8.3% (n = 3) did not have any cardiovascular symptoms but ∆LVEF decreased more than 10% and toxic effect of treatment on the heart was detected in 52.8% (n = 19) of all participants of the study. Conclusion: The patients under the breast cancer chemotherapy are inquired cardiotoxicity risk assessment before chemotherapy, and clinical guidelines for cardiotoxicity and close co-operation of oncologist and cardiologist are urgently needed.