Introduction: The improvement of survival in patients with cancer and the expansion of therapeutic options have led to the emergence of a new profile of cardiotoxicity, specifically associated with antimitotic agents. Our study aimed to assess the incidence of chemotherapy-induced myocardial toxicity in patients with cancer. Patients and Methods: We conducted a looking-forward longitudinal cohort study including all patients admitted to the Cardiology departments of Aristide le Dantec Hospital and Dalal Jamm National Hospital Centre for apre-chemotherapy check-up. The included patients did not undergo any pre-existing cardiopathy. Results: Over a period of two years ranging from January 2019 to December 2021, a total of 37 patients were included in the study. Notably, there was a female predominance (92%) with an average age of 49.7 years ± 13.69. Breast cancer accounted for 70% of the neoplasms. Laboratory findings revealed moderate anemia in 19 patients (51%). At inclusion, the left ventricle (LV) was of normal size (LV diastole at 44.46 ± 4.97 mm). The systolic function of the left ventricle was normal in all patients, with an average ejection fraction (EF) of 63.1% ± 5.80 and a mean global longitudinal strain (GLS) of ？20.4% ± 2.58. The most commonly used agents were anthracyclines. During follow-up, 3 patients (8.1%) developed clinical symptoms of left heart failure, and LV dysfunction on echocardiography was observed in 5 (13.5%) patients, with a significant decrease in EF < 50%. Overall, we observed a significant decline in mean global longitudinal strain and average EF at 3 months (p < 0.000) and 6 months (p < 0.000). Among 14 patients (8 at 3 months, 6 at 6 months), a decrease in delta strain ≥ 15% was noted, and 5 of them (13.5%) developed LV dysfunction during subsequent follow-up. Conclusion: The incidence of cardiac toxicity is not negligible, hence the importance of early screening. Strain imaging is an essential tool that should be performed as part of the assessment before chemotherapy and re-evaluated during treatment.
References
[1]
Bouri, N.V., Ba, O., Dieme, J.L., Mbengue, M., Boye, A., Fall, T., et al. (2017) État des lieux du registre des tumeurs au Sénégal: Bilan à 6ans d’enregistrement en ligne. Revue des Maladies Respiratoires, 34, A75. https://doi.org/10.1016/j.rmr.2016.10.156
[2]
CIRC (2022) Rapport biennal du CIRC 2020-2021. Centre International de Recherche sur le Cancer. https://publications.iarc.fr/613
[3]
Monsuez, J.J. (2009) Complications cardiaques des chimiothérapies anticancéreuses: Aspects cliniques [Cardiac Side Effects of Anticancer Drugs: Clinical Perspectives]. La lettre du Cancérologue, 18, 257-263.
[4]
Dumas, G. and Canet, E. (2016) Cardiovascular Toxicity Due to Chemotherapy, Targeted Therapies, and Immunosuppressive Drugs: A Narrative Review. Réanimation, 25, 123-136. https://doi.org/10.1007/s13546-015-1161-4
[5]
Curigliano, G., Cardinale, D., Dent, S., Criscitiello, C., Aseyev, O., Lenihan, D., et al. (2016) Cardiotoxicity of Anticancer Treatments: Epidemiology, Detection, and Management. CA: A Cancer Journal for Clinicians, 66, 309-325. https://doi.org/10.3322/caac.21341
[6]
Charbonnel, C., Convers-Domart, R., Rigaudeau, S., Taksin, A.L., Baron, N., Lambert, J., et al. (2017) Assessment of Global Longitudinal Strain at Low-Dose Anthracycline-Based Chemotherapy, for the Prediction of Subsequent Cardiotoxicity. European Heart Journal—Cardiovascular Imaging, 18, 392-401. https://doi.org/10.1093/ehjci/jew223
[7]
Paraskevaidis, I.A., Makavos, G., Tsirigotis, P., Psarogiannakopoulos, P., Parissis, J., Gkirkas, K., et al. (2017) Deformation Analysis of Myocardial Layers Detects Early Cardiac Dysfunction after Chemotherapy in Bone Marrow Transplantation Patients: A Continuous and Additive Cardiotoxicity Process. Journal of the American Society of Echocardiography, 30, 1091-1102. https://doi.org/10.1016/j.echo.2017.07.010
[8]
López-Fernández, T., Couch, L.S., Aznar, M.C., et al. (2022) 2022 ESC Guidelines on Cardio-Oncology Developed in Collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). European Heart Journal, 43, 4229-4361.
[9]
Cohen, A. and Soulat-Dufour, L. (2017) Fonction ventriculaire Dans Echocardiographie en pratique. Médecine Sciences Publications.
[10]
Abuodha, J.O., Shaikh, A.J., Shah, J., et al. (2020) Anthracycline Associated Cardiotoxicity in a Sub-Saharan African Population—Tertiary Care Experience. https://doi.org/10.21203/rs.3.rs-17301/v1
[11]
Diallo, M., Gueye, M., Gueye, S.M.K., Gueye, M.D.N., Gassama, O., Diouf, A.A., et al. (2017) Breast Cancer Recurrences at the of Senology Unit and Medical Oncology of the Aristide Le Dantec Hospital of Dakar. Gynecology & Reproductive Health, 1, 1-4. https://doi.org/10.33425/2639-9342.1006
[12]
Kane, S.M., Gueye, M., Coulbary, S.A., Diouf, A. and Moreau, J.C. (2016) Problématique de la prise en charge des cancers du sein au Sénégal: Une approche transversale. Pan African Medical Journal, 25, Article 3. https://doi.org/10.11604/pamj.2016.25.3.3785
[13]
Ndiaye, M., Dieng, S., Thiam, J., Diallo, A.C., Diouf, D., Ka, S., et al. (2021) Evaluation des facteurs pronostiques dans le cancer du sein chez la femme au Sénégal: À propos de 288 cas. African Journal of Oncology, 1, 4-9. https://doi.org/10.54266/ajo.1.1.6.6
[14]
Mousavi, N., Tan, T.C., Ali, M., Halpern, E.F., Wang, L. and Scherrer-Crosbie, M. (2015) Echocardiographic Parameters of Left Ventricular Size and Function as Predictors of Symptomatic Heart Failure in Patients with a Left Ventricular Ejection Fraction of 50-59% Treated with Anthracyclines. European Heart Journal—Cardiovascular Imaging, 16, 977-984. https://doi.org/10.1093/ehjci/jev113
[15]
Bertinchant, J.P., Polge, A., Juan, J.M., Oliva-Lauraire, M.C., Giuliani, I., Marty-Double, C., et al. (2003) Evaluation of Cardiac Troponin I and T Levels as Markers of Myocardial Damage in Doxorubicin-Induced Cardiomyopathy Rats, and Their Relationship with Echocardiographic and Histological Findings. Clinica Chimica Acta, 329, 39-51. https://doi.org/10.1016/s0009-8981(03)00013-5
[16]
Sawaya, H., Sebag, I.A., Plana, J.C., et al. (2012) Assessment of Echocardiography and Biomarkers for the Extended Prediction of Cardiotoxicity in Patients Treated with Anthracyclines, Taxanes, and Trastuzumab. Circulation: Cardiovascular Imaging, 5, 596-603.
[17]
Schwartz, R.G., McKenzie, W.B., Alexander, J., Sager, P., D'Souza, A., Manatunga, A., et al. (1987) Congestive Heart Failure and Left Ventricular Dysfunction Complicating Doxorubicin Therapy. The American Journal of Medicine, 82, 1109-1118. https://doi.org/10.1016/0002-9343(87)90212-9
[18]
Florescu, M., Magda, L.S., Enescu, O.A., Jinga, D. and Vinereanu, D. (2014) Early Detection of Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer. Journal of the American Society of Echocardiography, 27, 83-92. https://doi.org/10.1016/j.echo.2013.10.008
[19]
Boyd, A., Stoodley, P., Richards, D., Hui, R., Harnett, P., Vo, K., et al. (2017) Anthracyclines Induce Early Changes in Left Ventricular Systolic and Diastolic Function: A Single Centre Study. PLOS ONE, 12, e0175544. https://doi.org/10.1371/journal.pone.0175544
[20]
Fallah-Rad, N., Walker, J.R., Wassef, A., Lytwyn, M., Bohonis, S., Fang, T., et al. (2011) The Utility of Cardiac Biomarkers, Tissue Velocity and Strain Imaging, and Cardiac Magnetic Resonance Imaging in Predicting Early Left Ventricular Dysfunction in Patients with Human Epidermal Growth Factor Receptor Ii-Positive Breast Cancer Treated with Adjuvant Trastuzumab Therapy. Journal of the American College of Cardiology, 57, 2263-2270. https://doi.org/10.1016/j.jacc.2010.11.063
[21]
Baratta, S., Damiano, M.A., Marchese, M.L., et al. (2013) Serum Markers, Conventional Doppler Echocardiography and Two-Dimensional Systolic Strain in the Diagnosis of Chemotherapy-Induced Myocardial Toxicity. Revista Argentina de Cardiología, 81, 139-146.
[22]
Negishi, K., Negishi, T., Hare, J.L., Haluska, B.A., Plana, J.C. and Marwick, T.H. (2013) Independent and Incremental Value of Deformation Indices for Prediction of Trastuzumab-Induced Cardiotoxicity. Journal of the American Society of Echocardiography, 26, 493-498. https://doi.org/10.1016/j.echo.2013.02.008
[23]
Jensen, B.V., Skovsgaard, T. and Nielsen, S.L. (2002) Functional Monitoring of Anthracycline Cardiotoxicity: A Prospective, Blinded, Long-Term Observational Study of Outcome in 120 Patients. Annals of Oncology, 13, 699-709. https://doi.org/10.1093/annonc/mdf132
[24]
Pio, M., Adoubi, K., Adoh, A., Didi-Kouko, C., Anzouan-Kacou, J.B., Tegnan, A., et al. (2013) Dépistage précoce de la cardiotoxicité des anthracyclines par l’écho-Doppler tissulaire à propos de 45 cas à l’institut de cardiologie d’Abidjan. Annales de Cardiologie et d’Angéiologie, 62, 28-33. https://doi.org/10.1016/j.ancard.2012.03.002
[25]
Mornoş, C. and Petrescu, L. (2013) Early Detection of Anthracycline-Mediated Cardiotoxicity: The Value of Considering Both Global Longitudinal Left Ventricular Strain and Twist. Canadian Journal of Physiology and Pharmacology, 91, 601-607. https://doi.org/10.1139/cjpp-2012-0398
[26]
Oikonomou, E.K., Kokkinidis, D.G., Kampaktsis, P.N., Amir, E.A., Marwick, T.H., Gupta, D., et al. (2019) Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity. JAMA Cardiology, 4, 1007-1018. https://doi.org/10.1001/jamacardio.2019.2952
