Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer.
10.4048/jbc.2013.16.2.178
- Author:
Woo Baek CHUNG
1
;
Jeong Eun YI
;
Jung Yeon JIN
;
Yun Seok CHOI
;
Chan Seok PARK
;
Woo Chan PARK
;
Byung Joo SONG
;
Ho Joong YOUN
Author Information
1. Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. younhj@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Breast neoplasms;
Cardiac monitoring;
Cardiotoxicity;
Doxorubicin;
Trastuzumab
- MeSH:
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
- From:Journal of Breast Cancer
2013;16(2):178-183
- CountryRepublic of Korea
- Language:English
-
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.
