Turk Kardiyol Dern Ars. 2012; 40(7): 597-605 | DOI: 10.5543/tkda.2012.53896

Assessment of left ventricular systolic and diastolic function with conventional and tissue Doppler echocardiography imaging techniques in patients administered tyrosine kinase inhibitor

Yusuf İzzettin Alihanoğlu¹, Zeynettın Kaya², Hatem Arı³, Şükrü Karaarslan⁴, Bekir Serhat Yıldız¹, Mustafa Karanfil⁵, Mehmet Yazıcı⁵, Melih Cem Börüban⁶, Kurtuluş Özdemir⁵, Mehmet Sıddık Ülgen^7
1Department of Cardiology, Denizli State Hospital, Denizli, Turkey
²Department of Cardiology, Numune State Hospital, Konya, Turkey
³Department of Cardiology, Beyhekim State Hospital, Konya, Turkey
⁴Department of Cardiology, Nigde State Hospital, Nigde, Turkey
⁵Department of Cardiology Selcuk University, Meram Faculty of Medicine, Konya, Turkey
⁶Department of Oncology, Selcuk University, Meram Faculty of Medicine, Konya, Turkey
⁷Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey

OBJECTIVES
The aim of this study was to use echocardiographic techniques to determine the possible cardiotoxic effects of low molecular weight tyrosine-kinase inhibitors (TKI) in patients receiving the therapy for the first time.

STUDY DESIGN
Thirty patients (17 females; 13 males; mean age 49±16; range 22 to 76 years) who met the exclusion criteria and were diagnosed as having malignancy were enrolled. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI) prior to the treatment. The conventional echocardiogram was repeated 2 months later as the patients were concurrently receiving therapy. Myocardial Performance Index was obtained by conventional echocardiography and by TDI techniques to evaluate left ventricular systolic and diastolic function.

RESULTS
Statistically significant increase occurred in mean left ventricle (LV) end-systolic volume. However, there was significant decrease in both mean LV ejection fraction and LV stroke volume values (64±3, 62±4, p=0.000 and 67±13, 61±13, p=0.000, respectively). Anterior wall Em/Am ratio measured by using the TDI technique was significantly decreased at the end of two months (0.99±0.49, 0.90±0.41, p=0.03). In addition, decreases were determined in Sm values obtained from all of four LV walls and also in mean Sm value, but this decrease was significant only for the lateral wall Sm measurement (12.8±2.9, 11.6±2.3, p=0.004).

CONCLUSION
Tyrosine-kinase inhibitors therapy can be administered safely to patients without predisposing factors for cardiotoxicity in short treatment intervals, and low molecular TKIs may cause subtle or clinically significant cardiotoxicity following the treatment period even in patients without predisposing factors for cardiotoxicity, so clinicians should consider this possibility.

Keywords: Cardiotoxicity, echocardiography, Doppler; elasticity imaging techniques; heart failure/chemically induced; drug interactions; neoplasms/drug therapy; protein-tyrosine kinases/antagonists & inhibitors; ventricular function, left

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