Author + information
- Received July 6, 2012
- Revision received November 1, 2012
- Accepted November 16, 2012
- Published online August 1, 2013.
- Brandon C. Drafts, MD∗,
- Katie M. Twomley, MD∗,
- Ralph D'Agostino Jr., PhD†,
- Julia Lawrence, MD‡,
- Nancy Avis, PhD§,
- Leslie R. Ellis, MD‡,
- Vinay Thohan, MD∗,
- Jennifer Jordan, PhD¶,
- Susan A. Melin, MD‡,
- Frank M. Torti, MD‡,
- William C. Little, MD∗,
- Craig A. Hamilton, PhD¶ and
- W. Gregory Hundley, MD∗⋮∗ ()
- ∗Department of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- †Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- ‡Department of Internal Medicine, Section Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- §Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- ⋮Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- ¶Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. W. Gregory Hundley, Wake Forest University Health Sciences, Bowman Gray Campus, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045.
Objectives The goal of this study was to determine if low to moderate doses of anthracycline-based chemotherapy (Anth-bC) are associated with subclinical cardiovascular (CV) injury.
Background Cancer survivors who receive Anth-bC experience premature CV events. It is unknown whether low to moderate doses of anthracyclines promote early subclinical CV disease manifested by deteriorations in left ventricular ejection fraction (LVEF) or increases in aortic stiffness, or if these doses are associated with changes in quality of life (QOL).
Methods In 53 men and women with breast cancer, leukemia, or lymphoma, we assessed left ventricular volumes, LVEF, circumferential strain, aortic pulse wave velocity, late gadolinium enhancement, serum B-type natriuretic peptide, troponin I, and the impact of treatment on QOL before and 1, 3, and 6 months after receipt of Anth-bC.
Results Participants averaged 50 ± 2 (range 19 to 80) years in age, 58% were women, 17% were black, and they each received a range of 50 to 375 mg/m2 of doxorubicin-equivalent chemotherapy. Left ventricular end-systolic volume (48 ± 3 ml to 54 ± 3 ml; p = 0.02), left ventricular strain (–17.7 ± 0.4 to –15.1 ± 0.4; p = 0.0003), pulse wave velocity (6.7 ± 0.5 m/s to 10.1 ± 1 m/s; p = 0.0006), and QOL deterioration (15.4 ± 3.3 to 28.5 ± 3.9; p = 0.008) increased, whereas LVEF (58 ± 1% to 53 ± 1%; p = 0.0002) decreased within 6 months after low to moderate doses of Anth-bC. All findings persisted after accounting for age, gender, race (white/black), doxorubicin-equivalent dose, doxorubicin administration technique, comorbidities associated with CV events, and cancer diagnosis (p = 0.02 to 0.0001 for all). There were no new late gadolinium enhancement findings after 6 months.
Conclusions In these study patients, low to moderate doses of Anth-bC were associated with the early development of subclinical abnormalities of cardiac and vascular function that in other populations are associated with the future occurrence of CV events.
This research was supported in part by grants from the National Institutes of Health (R33CA12196, R01HL076438, M01RR07122, and P30CA012197) and a grant (BCTR0707769) from the Susan G. Komen Foundation. Dr. Hundley has received research grant support from the National Institutes of Health, Siemens, Bracco, and Prova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 6, 2012.
- Revision received November 1, 2012.
- Accepted November 16, 2012.
- American College of Cardiology Foundation