Turk Kardiyol Dern Ars. 2011; 39(8): 646-653 | DOI: 10.5543/tkda.2011.01700

Can comprehensive echocardiographic evaluation provide an advantage to predict anthracycline-induced cardiomyopathy?

Doğan Erdoğan¹, Habil Yücel¹, Emine Güçhan Alanoğlu², Bayram Ali Uysal¹, Murat Koçer², Mehmet Özaydın¹, Abdullah Doğan^1
1Suleyman Demirel University, Faculty Of Medicine, Cardiology Department, Isparta, Turkey
²Suleyman Demirel University, Faculty Of Medicine, Internal Medicine Department, Isparta, Turkey

OBJECTIVES
No definite markers have been established to identify patients in whom anthracycline-containing chemotherapy may represent a high risk for the development of cardiotoxicity. We aimed to evaluate the predictive value of comprehensive echocardiography in anthracycline-induced cardiomyopathy.

STUDY DESIGN
In a prospective design, the study included 39 patients (9 males, 30 females; mean age 53.7±11.5 years) who received antineoplastic therapy including anthracycline. Comprehensive echocardiographic examination including tissue Doppler imaging and coronary flow reserve was performed before treatment with anthracycline and at the end of a six-month follow-up.

RESULTS
Eight patients (20.5%) developed cardiomyopathy during the follow-up period. Compared to patients with unaffected left ventricular ejection fraction at 6 months, patients with cardiomyopathy exhibited significant differences in baseline left ventricular systolic diameter, mitral E/A, E-wave deceleration time, Sm, Em, Em/Am ratio, Sm-Em duration, and the Tei index. In univariate logistic regression analysis, only Sm (OR 0.40, p=0.002) and the Tei index (OR 3.24, p=0.02) were significant variables for the development of cardiotoxicity. These two were also the only independent predictors of anthracycline cardiotoxicity in multivariate linear regression analysis. Receiver operating characteristic curve analysis yielded a cut-off value of 8 cm/sec for Sm and 0.38 for the Tei index to predict cardiomyopathy.

CONCLUSION
Our findings suggest that Sm and myocardial performance index (the Tei index) are significant independent markers to identify patients at high risk for the development of anthracycline-induced cardiomyopathy.

Keywords: Anthracyclines/adverse effects, cardiomyopathies; drug interactions; echocardiography, Doppler; myocardial contraction; neoplasms/drug therapy; ventricular function, left

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