Myocardial dysfunction in long-term breast cancer survivors treated at ages 40-50 years.

Autor: Jacobse JN; Department of Epidemiology & Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands., Steggink LC; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands., Sonke GS; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Schaapveld M; Department of Epidemiology & Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands., Hummel YM; Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands., Steenbruggen TG; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Lefrandt JD; Department of Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands., Nuver J; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands., Crijns APG; Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands., Aleman BMP; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., van der Meer P; Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands., Gietema JA; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands., van Leeuwen FE; Department of Epidemiology & Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2020 Feb; Vol. 22 (2), pp. 338-346. Date of Electronic Publication: 2019 Nov 06.
DOI: 10.1002/ejhf.1610
Abstrakt: Aims: Anthracyclines increase heart failure (HF) risk, but the long-term prevalence of myocardial dysfunction in young breast cancer (BC) survivors is unknown. Early measures of left ventricular myocardial dysfunction are needed to identify BC patients at risk of symptomatic HF.
Methods and Results: Within an established cohort, we studied markers for myocardial dysfunction among 569 women, who were 5-7 years (n = 277) or 10-12 years (n = 292) after BC treatment at ages 40-50 years. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were assessed by echocardiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) was measured in serum. Associations between patient-related and treatment-related risk factors and myocardial dysfunction were evaluated using linear and logistic regression. Median ages at BC diagnosis and cardiac assessment were 46.7 and 55.5 years, respectively. Anthracycline-treated patients (n = 313), compared to the no-anthracycline group (n = 256), more often had decreased LVEF (10% vs. 4%), impaired GLS (34% vs. 27%) and elevated NT-proBNP (23% vs. 8%). GLS and LVEF declined in a linear fashion with increasing cumulative anthracycline dose (GLS: +0.23 and LVEF: -0.40 per cycle of 60 mg/m 2 ; P < 0.001) and GLS was worse for patients with left breast irradiation. The risk of NT-proBNP >125 ng/L was highest for patients who received 241-300 mg/m 2 anthracycline dose compared to the no-anthracycline group (odds ratio: 3.30, 95% confidence interval: 1.83-5.96).
Conclusion: Impaired GLS and increased NT-proBNP levels are present in a substantial proportion of young BC survivors treated with anthracyclines. Whether this will lead to future cardiac disease needs to be evaluated by longitudinal assessment.
(© 2019 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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