J Breast Cancer.  2013 Jun;16(2):178-183. 10.4048/jbc.2013.16.2.178.

Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer

• Chung WB
• Yi JE
• Jin JY
• Choi YS
• Park CS
• Park WC
• Song BJ
• Youn HJ

• KMID: 2286398
• DOI: http://doi.org/10.4048/jbc.2013.16.2.178

Abstract

PURPOSE
As doxorubicin cardiotoxicity is considered irreversible, early detection of cardiotoxicity and prevention of overt heart failure is essential. Although there are monitoring guidelines for cardiotoxicity, optimal timing for early detection of subclinical doxorubicin cardiotoxicity is still obscure. The purpose of this study is to determine optimal timing of cardiac monitoring and risk factors for early detection of doxorubicin cardiotoxicity in young adult patients with breast cancer.
METHODS
Medical records of 1,013 breast cancer patients diagnosed from January 2009 to December 2010 is being reviewed and analyzed. Properly monitored patients are defined as patients who underwent transthoracic echocardiography before and after the chemotherapy. The definition of subclinical cardiotoxicity (SC) either decreases left ventricular ejection fraction (LVEF) more than 10% or the LVEF declines under 55% from baseline without heart failure symptoms.
RESULTS
Twenty-nine out of 174 (16.7%) properly monitored young adult female patients (mean age, 52+/-10 years old) developed SC. The mean interval of cardiac evaluation of SC group was 5.5+/-3.0 months. Among the risk factors, the history of coronary artery disease, cumulative dose of doxorubicin > or =300 mg/m2 and use of trastuzumab after doxorubicin therapy were associated with development of SC. At cumulative dose of doxorubicin 244.5 mg/m2, SC can be predicted (sensitivity, 71.4%; specificity, 70.9%; area under the curve, 0.741; 95% confidence interval, 0.608-0.874; p=0.001).
CONCLUSION
In young adult patients with breast cancer, SC was common at cumulative dose of doxorubicin <300 mg/m2 and early performance of cardiac monitoring before reaching the conventional critical dose of doxorubicin might be a proper strategy for early detection of SC.

Keyword

Breast neoplasms; Cardiac monitoring; Cardiotoxicity; Doxorubicin; Trastuzumab

MeSH Terms

Antibodies, Monoclonal, Humanized
Breast
Breast Neoplasms
Coronary Artery Disease
Doxorubicin
Echocardiography
Female
Heart Failure
Humans
Medical Records
Risk Factors
Sensitivity and Specificity
Stroke Volume
Young Adult
Trastuzumab
Antibodies, Monoclonal, Humanized
Doxorubicin

Figure

• 

  Figure 1 Time period to the first follow-up of cardiac function monitoring after initial doxorubicin therapy. Varying times to first follow-up transthoracic echocardiography after the initial dose of doxorubicin demonstrates the lack of uniformity in cardiac function monitoring during chemotherapy.

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  Figure 2 Receiver operating characteristics curve to determine the cumulative dosage of doxorubicin that predicts subclinical cardiotoxicity. Area under the curve and 95% confidence interval are 0.741 (0.608-0.874, p=0.001).

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