Evaluating risk factors patients with chemotherapy induced diastolic dysfunction

Abstract

Background: Chemotherapy has shown great progress last decades, leading to the gradual increase in the survival of cancer patients. However along with this benefit, the cardiovascular side effects of modern anticancer agents have also proven to be an increasing problem and have become important issues to early detect and treat for chemotherapy induced cardiomyopathy. Diastolic dysfunction is an earlier marker for a lot of cardiac diseases and can be diagnosed by echocardiograpy. Purpose: Assessing diastolic dysfunction by TTE among breast cancer patients undergoing chemotherapy Methods: This cross-sectional, longitudinal study comprised 36 consecutive female patients receiving chemotherapy for breast cancer between November 2019 and January 2020 in National Cancer Center. All patients underwent questionnaire, clinical evaluation, electrocardiogram and echocardiogram two visits at 3 months after and before chemotherapy. Echocardiographic images were obtained by using a ultrasonographic equipment Philips HD7 XE. Diastolic function was classified as “normal”, “impaired relaxation”, “pseudonormal” and “restricted” according to the recommendations of the American Society of Echocardiography. Results: The study population 36 consecutive patients (with ages 28 and 61 years) receiving chemotherapy for breast cancer. The pateints are 100% female (n=36), mean age was 47±9.3, mean weight was 71.4±15.06 . There was significant decrease diastolic parameters that E/A (p=0.01) бa S/D (p=0.03) by 2D echocardiography. We also found significant decrease E/ sep(p=0.01), A/ sep (p=0.005) and significant increase E/e/ sep (p=0.04) in tissue Doppler. That is illustrated to increase diastolic parameter three months after chemotherapy and 52% (n=11) out 21 patients (without diastolic dysfunction in the first visit) had diastolic dysfunction newly diagnosed via echocardiography. We found significant increase in age (49±8.8), body mass index (29±4.1), course of chemotherapy (5.3±0.75) in DD+ group from DDgroup and 22 of 26 patients diastolic dysfunction with systolic dysfunction (cardiotoxicity). On multivariate regression analysis body mass index (r=0.147 p=0.003), old age (r=0.261 p=0.001), and EF (r=0.141, p=0.004) were significant independent predictors of chemotherapy induced diastolic dysfunction. In logistic regression, age, OR1.06 (95% Cl: 1.01-1.12, p=0.02), BMI, OR-1.12 (95% Cl: 1.04-1.20, p=0.01). 92%(23) out 26 patients with diastolic dysfunction used anthracycline. Conclusion: Diastolic dysfunction was newly diagnosed in 11 patients undergoing 3 courses of chemotherapy. The incidences were higher among the patients who higher BMI, age and using anthracyclines.