Body Surface Area and Baseline Blood Pressure Predict Subclinical Anthracycline Cardiotoxicity in Women Treated for Early Breast Cancer
Kotwinski, Paul (East and North Hertfordshire NHS Trust (Stevenage, Regne Unit))
Smith, Gillian (Royal Brompton Hospital (Londres))
Cooper, Jackie (University College London)
Sanders, Julie (Institute for Human Health and Performance (Londres))
Ma, Louise (Institute for Human Health and Performance (Londres))
Teis, Albert (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Kotwinski, David (Institute for Human Health and Performance (Londres))
Mythen, Michael (University College Hospital (Londres))
Pennell, Dudley J. (Royal Brompton Hospital (Londres))
Jones, Alison (UCL Institute of Cardiovascular Science (Londres))
Montgomery, Hugh (Institute for Human Health and Performance (Londres))

Data:	2016
Resum:	Background and aims: Anthracyclines are highly effective chemotherapeutic agents which may cause long-term cardiac damage (chronic anthracycline cardiotoxicity) and heart failure. The pathogenesis of anthracycline cardiotoxicity remains incompletely understood and individual susceptibility difficult to predict. We sought clinical features which might contribute to improved risk assessment. Methods: Subjects were women with early breast cancer, free of pre-existing cardiac disease. Left ventricular ejection fraction was measured using cardiovascular magnetic resonance before and >12 months after anthracycline-based chemotherapy (>3 months post-Trastuzumab). Variables associated with subclinical cardiotoxicity (defined as a fall in left ventricular ejection fraction of ≥5%) were identified by logistic regression. Results: One hundred and sixty-five women (mean age 48. 3 years at enrollment) completed the study 21. 7 months [IQR 18. 0-26. 8] after starting chemotherapy. All received anthracyclines (98. 8% epirubicin, cumulative dose 400 [300-450] mg/m2); 18% Trastuzumab. Baseline blood pressure was elevated (≥140/90mmHg, mean 147. 3/86. 1mmHg) in 18 subjects. Thirty-four subjects (20. 7%) were identified with subclinical cardiotoxicity, independent predictors of which were the number of anthracycline cycles (odds ratio, OR 1. 64 [1. 17-2. 30] per cycle), blood pressure ≥140/90mmHg (OR 5. 36 [1. 73-17. 61]), body surface area (OR 2. 08 [1. 36-3. 20] per standard deviation (0. 16m2) increase), and Trastuzumab therapy (OR 3. 35 [1. 18-9. 51]). The resultant predictive-model had an area under the receiver operating characteristics curve of 0. 78 [0. 70-0. 86]. Conclusions: We found subclinical cardiotoxicity to be common even within this low risk cohort. Risk of cardiotoxicity was associated with modestly elevated baseline blood pressure-indicating that close attention should be paid to blood pressure in patients considered for anthracycline based chemotherapy. The association with higher body surface area suggests that indexing of anthracycline doses to surface area may not be appropriate for all, and points to the need for additional research in this area.
Nota:	This work was supported by the United Kingdom Department of Health under the Pharmacogenetics Research programme (grant number PHGX23A).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Mama ; Càncer ; Hipertensió
Publicat a:	PloS one, Vol. 11 Núm. 12 (December 2016) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0165262
PMID: 27911951

17 p, 1.2 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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