Valvular Heart Disease following Anthracycline Therapy-Is It Time to Look beyond Ejection Fraction?

The association between anthracycline (ANT) and left ventricle (LV) dysfunction is well known; however, data regarding its direct effect on cardiac valve function is limited. We aimed to evaluate how ANT therapy affected valvular function in patients diagnosed with breast cancer. Data were prospecti...

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Bibliographic Details
Published in:Life (Basel, Switzerland) Switzerland), 2022-08, Vol.12 (8), p.1275
Main Authors: Zahler, David, Arnold, Joshua H, Bar-On, Tali, Raphael, Ari, Khoury, Shafik, Rozenbaum, Zach, Banai, Shmuel, Arbel, Yaron, Topilsky, Yan, Laufer-Perl, Michal
Format: Article
Language:English
Subjects:
Anthracycline
Breast cancer
Cancer therapies
cardio-oncology
Cardiotoxicity
Cardiovascular disease
Cardiovascular diseases
Coronary artery disease
Echocardiography
Ejection fraction
Heart
Heart diseases
Heart valves
Longitudinal studies
mitral regurgitation
Mortality
Radiation
Regurgitation
Rheumatic heart disease
Software
Therapy
Trastuzumab
Trends
tricuspid regurgitation
valve
Ventricle
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Summary:The association between anthracycline (ANT) and left ventricle (LV) dysfunction is well known; however, data regarding its direct effect on cardiac valve function is limited. We aimed to evaluate how ANT therapy affected valvular function in patients diagnosed with breast cancer. Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). Patients underwent echocardiography exams at baseline (T1), during ANT therapy (T2), and after completion within 3 months (T3) and 6 months (T4). A total of 141 female patients were included, with a mean age of 51 ± 12 years. From T1 to T4, we observed a significant deterioration in LV ejection fraction (60.2 ± 1.5 to 59.2 ± 2.7%, p = 0.0004) and LV global longitudinal strain (−21.6 (−20.0−−23.0) to −20.0 (−19.1−−21.1)%, p < 0.0001)), and an increase in LV end-systolic diameter (25 (22−27) to 27 (24−30) mm, p < 0.0001). We observed a significant increase in the incidence of new mitral regurgitation (MR) development (4 to 19%, p < 0.0001), worsening with concomitant trastuzumab therapy (6% to 31%, p = 0.003), and a trend for tricuspid regurgitation development (4% to 8%, p = 0.19). ANT therapy is associated with the development of a new valvular disease, mainly MR, which may imply the need for a valvular focus in the monitoring of cancer patients.
ISSN:2075-1729
2075-1729
DOI:10.3390/life12081275