Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Abstract Background: Chemotherapeutic agents of anthracyclines class and humanized monoclonal antibodies are effective treatments for breast cancer, however, they present a potential risk of cardiotoxicity. Several predictors have been recognized as predictors in the development of cardiac toxicity, and the evaluation of left ventricular segmental wall motion abnormalities (LVSWMA) has not been studied. Objective: To analyze prospectively the role of LVSWMA among echocardiographic parameters in the prediction of development of cardiotoxicity in breast cancer patients undergoing treatment with chemotherapy. Methods: Prospective cohort of patients diagnosed with breast cancer and in chemotherapy treatment with potential cardiotoxicity medications including doxorubicin and trastuzumab. Transthoracic echocardiograms including speckle tracking strain echocardiography were performed at standard times before, during and after the treatment to assess the presence (or lack thereof) of cardiotoxicity. Cardiotoxicity was defined by a 10% decrease in the left ventricular ejection fraction, on at least one echocardiogram. Multivariate logistic regression models were used to verify the predictors related to the occurrence of cardiotoxicity over time. Results: Of the 112 patients selected (mean age 51,3 ± 12,9 years), 18 participants (16.1%) had cardiotoxicity. In the multivariate analysis using the logistic regression model, those with LVWMA (OR = 6.25 [CI 95%: 1.03; 37.95], p摘要 背景：蒽环类化疗药物与人源化单克隆抗体是乳腺癌的有效治疗方案，但二者均存在潜在心脏毒性风险。目前已明确多种心脏毒性发生的预测因子，但针对左心室节段性室壁运动异常（left ventricular segmental wall motion abnormalities, LVSWMA）的评估相关研究仍较为匮乏。 目的：前瞻性分析超声心动图参数中的左心室节段性室壁运动异常，在接受化疗的乳腺癌患者心脏毒性发生预测中的应用价值。 方法：本研究为前瞻性队列研究，纳入经确诊且接受潜在心脏毒性化疗药物（包括多柔比星与曲妥珠单抗）治疗的乳腺癌患者。在治疗前、治疗期间及治疗后的标准时间节点，对受试者行经胸超声心动图检查，其中包含斑点追踪应变超声心动图，以评估心脏毒性的发生情况。心脏毒性的定义为：至少一次超声心动图检查显示左心室射血分数降低10%。采用多变量logistic回归模型，验证随时间推移与心脏毒性发生相关的预测因子。 结果：共纳入112例患者，平均年龄为51.3±12.9岁，其中18例（16.1%）发生心脏毒性。在logistic回归模型的多变量分析中，存在左心室节段性室壁运动异常的患者其心脏毒性发生风险为无异常者的6.25倍[95%置信区间CI：1.03；37.95]，P值