Anthracycline Chemotherapy-Induced Electro-Mechanical Changes: Strain Echocardiography Combined with Repolarization Parameters on Electrocardiography to Predict Early Cardiotoxicity

OBJECTIVE
The aim of the study was to describe the acute cardiotoxic effects of anthracycline chemotherapy in echocardiographic strain and electrocardiographic repolarization parameters in patients with breast cancer.


METHODS
A total of 35 consecutive patients (all females, mean age: 48.9 ± 11.8 years) who received chemotherapy due to breast cancer were prospectively included. Pre-treatment (T0) and third month (T2) 2-dimensional strain echocardiography and electrocardiography were performed. Additionally, within 3 hours of the first dose of chemotherapy (T1), additional elec-trocardiographic images were obtained. All mechanical and electrical parameters from different time intervals (T0, T1, and T2) were compared with each other.


RESULTS
In the acute period after treatment, electrocardiographic repolarization parameters were prolonged and this prolongation continued to the third month (QT corrected with Bazett formula [440.10 ± 27.63 (T0), 468.00 ± 38.98 (T1), 467.86 ± 35.09 (T2)], QT dispersion
[49.85  ± 19.52 (T0), 69.54 ± 16.06 (T1), 57.63 ± 14.42 (T2)], and T-wave peak-to-end interval [94.00 ± 45.46 (T0), 131.20 ± 17.79 (T1), 120.00 ± 18.32 (T2)]; P <.001). There
was no significant change in global longitudinal strain values before and after treatment (global
longitudinal strain avg: −21 ± 7.1%; P =.8). However, there were significant reductions in strain parameters including circumferential and radial strain, and torsion (−17.2 ± 3.5 to -13 ± 2.84; P  < .001, 45.1 ± 8.3 to 35.6 ± 10; P <.001, and 12.1 ± 3.5 to 7.7 ± 2.1; P <.001, respectively).


CONCLUSION
Both the electrical and mechanical functions of the heart can be impaired acutely extending to 3 months after anthracycline chemotherapy. Therefore, cardiotoxicity should be evaluated early both electrically and mechanically after chemotherapy.