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Anthracycline therapy decreases LV mass in breast cancer
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Women with breast cancer who underwent anthracycline therapy had a decrease in left ventricular mass that potentially resulted from cardiomyocyte atrophy, according to a study published in JACC: Cardiovascular Imaging.
Thiago Ferreira de Souza, MD, of the School of Medical Sciences at the State University of Campinas in São Paulo, and colleagues analyzed data from 27 women (mean age, 52 years) with breast cancer and planned adjuvant anthracycline-based therapy between 2012 and 2015. Women were excluded if they had kidney disease, contraindications to cardiac MRI, clinical diagnosis of HF, previous MI or moderate and severe valve disease.
Cardiac MRI was performed at baseline and up to three times serially after anthracycline treatment. Other data that were collected included laboratory evaluation, standard anthropometric data and detailed medical history.
Women had a median 10-year Framingham CV event risk of 5% at baseline, a mean LV ejection fraction of 69.4% and a mean LV mass index of 51.4 g/m2.
Extracellular volume increased by 11% from 0.32 at baseline to 0.36 between 350 and 700 days (P = .0035). Intracellular water lifetime decreased by 62 ms during this time after anthracycline treatment (P = .004). There was no late gadolinium enhancement during this time.
At 351 to 700 days after anthracycline therapy, mean LV mass index decreased by 19 g/m2 and LVEF declined by 12% (P for both < .001).
Myocardial edema peaked from 146 to 231 days (P < .001).
Although LV mass index was not associated with extracellular volume, it was associated with intracellular water lifetime (beta = 4.1 per 100-ms increase; P = .007). After anthracycline treatment, cardiac troponin T increased (P < .001). Total LV cardiomyocyte mass declined more rapidly after treatment, and the peak cardiac troponin T was greater than 10 pg/mL.
Age-adjusted risk increment and Framingham 10-year risk were not linked to LV remodeling after anthracycline therapy.
“This raises important issues for patients being examined for identification of cardiac toxicity upon receipt of anthracycline-based chemotherapy and for other medical conditions that may require them to undergo [cardiac MRI] and experience an increase in [extracellular volume fraction],” W. Gregory Hundley, MD, professor of cardiology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and Jennifer H. Jordan, PhD, assistant professor of cardiology at Wake Forest School of Medicine, wrote in a related editorial. “One needs to consider whether this expansion is related to a change in the numerator, the denominator, or both.” – by Darlene Dobkowski
Disclosures: De Souza, Hundley and Jordan report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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