Contraction Timing Patterns in Patients Treated for Breast Cancer Before and After Anthracyclines Therapy

Kai-Hung Cheng; Mark D Handschumacher; Bruna Morhy Borges Leal Assuncao; Igal A Sebag; Elkan F Halpern; Marielle Scherrer-Crosbie

doi:10.1016/j.echo.2016.12.013

Contraction Timing Patterns in Patients Treated for Breast Cancer Before and After Anthracyclines Therapy

J Am Soc Echocardiogr. 2017 May;30(5):454-460. doi: 10.1016/j.echo.2016.12.013. Epub 2017 Mar 2.

Authors

Kai-Hung Cheng¹, Mark D Handschumacher², Bruna Morhy Borges Leal Assuncao², Igal A Sebag³, Elkan F Halpern⁴, Marielle Scherrer-Crosbie⁵

Affiliations

¹ Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine and Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
² Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
³ Echocardiography Laboratory and Cardiology Division, Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
⁴ Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.
⁵ Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiac Ultrasound Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: marielle@crosbie.com.

PMID: 28262302
DOI: 10.1016/j.echo.2016.12.013

Abstract

Background: During the development of heart failure (HF), the changes of contraction timing pattern and temporal heterogeneity of segmental contraction happen early and may precede both symptomatic HF and the decrease in left ventricular ejection fraction (LVEF). In patients treated with anthracyclines, both symptomatic HF and the decrease of LVEF are detected once significant myocardial injury has occurred. The aim of the current study was to investigate whether changes in the timing of contraction can be detected early after anthracyclines therapy.

Methods: Forty-one women (50 ± 11 years old) with newly diagnosed breast cancer were prospectively enrolled in two centers and underwent an echocardiogram before and after anthracyclines. Peak longitudinal myocardial systolic strain was measured on the apical four- and two-chamber views. The time to peak systolic longitudinal strain (TP), ejection time (ET), isovolumic contraction time (IVCT), systolic time, and diastolic time were measured using strain curves and Doppler tracings and compared before and after anthracyclines. The heterogeneity of contraction (dyssynchrony) was measured by the SD of the TP of all segments.

Results: Anthracyclines treatment was associated with an increase in heart rate (HR) and a decrease in TP. TP was correlated with HR. TP/ET was independent of HR and inversely correlated to peak strain both at baseline and after anthracyclines. TP/ET increased after anthracyclines (1.26 ± 0.19 to 1.31 ± 0.22; P < .001), and this increase was correlated with the decrease in strain. The increase in TP/ET was due to an increase in IVCT/ET. A similar degree of dyssynchrony was found at baseline and after anthracyclines.

Conclusions: Anthracyclines treatment induces an increase in the duration of contraction, mainly by increasing the IVCT. This increase is correlated to the decrease in strain and may therefore have additional prognostic value.

Keywords: Cardiac dysfunction; Chemotherapy; Dyssynchrony; Echocardiography; Time to peak strain.

Publication types

Multicenter Study

MeSH terms

Anthracyclines / administration & dosage*
Anthracyclines / adverse effects*
Antineoplastic Agents / administration & dosage
Antineoplastic Agents / adverse effects
Boston
Breast Neoplasms / drug therapy*
Breast Neoplasms / physiopathology
Controlled Before-After Studies
Excitation Contraction Coupling / drug effects
Female
Heart Failure / chemically induced
Heart Failure / diagnostic imaging
Heart Failure / physiopathology
Humans
Middle Aged
Myocardial Contraction / drug effects*
Quebec
Reproducibility of Results
Sensitivity and Specificity
Stroke Volume
Treatment Outcome
Ultrasonography / methods
Ventricular Dysfunction, Left / chemically induced*
Ventricular Dysfunction, Left / diagnostic imaging
Ventricular Dysfunction, Left / physiopathology*

Substances

Anthracyclines
Antineoplastic Agents