- Cardiotoxicity is when there is damage to the heart muscle
- It is set to increase the burden of heart failure in cancer survivors who also have diabetes.
- Cardiotoxicity can be reversed in the early stages before overt heart failure develops.
Heart damage caused by chemotherapy is worse in cancer patients who also have diabetes.
Dr Ana Catarina Gomes, the lead author, a cardiologist in training at the Hospital Garcia de Orta in Almada, Portugal said: "Surveillance programmes are hugely beneficial, particularly in the first year of treatment when up to 80% of the systolic dysfunction develops."
‘Cardiotoxicity induced by chemotherapy with anthracyclines is being increasingly reported, mainly because a smaller proportion of patients now die from cancer.’
Hospital Garcia de Orta has a surveillance programme, run by Cardiology, Oncology and Haematology, to monitor cancer patients who receive anthracycline-based chemotherapy. Clinical and echocardiographic evaluation is conducted before, during and after chemotherapy, regardless of whether or not the patient has symptoms. The aim of the surveillance programme is to detect cardiotoxicity early so that heart failure can be prevented.
The current study analyzed the effect of cardiovascular risk factors and type of cancer on the development of cardiotoxicity to help identify patients at greater risk.
83 patients were included in the surveillance programme, of whom
- 54 had breast cancer
- 20 had lymphoma
- 9 had gastric cancer
Out of the 83 patients, 39 were treated with doxorubicin and 44 received epirubicin. The average age group of the patients enrolled in the study was 52 years old. And 78% were female.
The data from the patients was collected based on the following
- Cardiovascular risk factors (high blood pressure, diabetes, high lipid levels, smoking), previous history of cardiovascular and non-cardiovascular diseases and type and cumulative dose of anthracylines.
Echocardiographic measurements were performed before chemotherapy was started, during the treatment and after the end of chemotherapy. Echocardiographic data was tested among patients with different types of cancer.
31% had hypertension, 7% had diabetes, 16% had dyslipidemia, and 16% were smokers.
Global longitudinal strain and left ventricular ejection fraction progressively decreased and were significantly lower after chemotherapy compared to baseline.
Patients with high blood pressure showed a trend toward greater reductions in ejection fraction.
Diabetic patients had a significantly greater decrease in global longitudinal strain during treatment, despite having baseline levels similar to non-diabetics.
Breast cancer patients had milder cardiotoxic effects compared to those with gastric cancer or lymphoma.
Dr Gomes said: " Subclinical reduction in global longitudinal strain is an early predictor of heart failure and was particularly pronounced in patients with diabetes.
It is possible that the trend for greater reduction in patients with hypertension might become statistically significant in a larger study."
"We hypothesise that cancers themselves could have direct cardiotoxic effects induced by cytokines," said Dr Gomes. "These cardiotoxic effects may vary with the type of cancer."
She concluded: "Cancer patients should strictly control cardiovascular risk factors with lifestyle changes and, if necessary, with medication. But of course cardiovascular prevention should never postpone the beginning of chemotherapy since treating cancer is the first priority."
The findings of the study presented at EuroEcho-Imaging 2016.