Cardiotoxic effect of antitumor therapy in the development of diastolic dysfunction of the left ventricle in women in the treatment of breast cancer

Methods
71 female patients with breast cancer (BC) were divided into groups according to the presence of arterial hypertension (AH) and cardiotropic therapy (CTT): ВС group with antitumor treatment alone (38 cases), ВС+CTT group – patients with antitumor treatment who received carvedilol combined with valsartan and had no hypertension (22 cases); ВС+ CTT + AH group – patients who had hypertension and received carvedilol combined with valsartan (11 cases).
Results
After completing the full course of treatment for breast cancer in BC group a decrease in transmitral flow ratio, an increase in myocardial mass, left ventricular mass index, meridional stress, left ventricular end-diastolic pressure and left ventricular end-diastolic stress wall (p<0,05) have been revealed.
Direct correlation between the degree of reduction of ejection fraction and increase in the left ventricular end-diastolic stress wall (r=0,34; р<0,05), as well as between decreased transmitral flow ratio and increased left ventricular end-diastolic stress wall (r=0,41; р<0,05) have been found.
Conclusions
The earliest changes in the structural and functional parameters of the left ventricle as a result of antitumor treatment are represented by some parameters of diastolic dysfunction.
The purpose of cardiotropic therapy is to reduce the cardiotoxic effect of chemoradiotherapy.

1. Shuykova K.V., Emelina E.I., Gendlin G.E., Storojakov G.I. Izmenenie funkzii levogo zheludochka serdza u bol'nych s limfomami na fone vvedeniya antraziklinovych antibiotikov [Change of the left ventricle functioning in lymphoma treated with anthracyclineantibiotics]. Rossiyskiy kardiologicheskiy zhurnal, 2016, no. 1, pp. 41-46. (in Russian).

2. Zamorano J.L., Lancellotti P., Rodriguez M.D., Aboyans V., Asteggiano R., Galderisi M., Habib G., Lenihan D.J., Lip G.Y.H., Lyon A.R., Lopez F.T, Mohty D., Piepoli M.F., Tamargo J., Torbicki A., Suter T.M. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J, 2016, vol. 37, no. 36, pp. 2768-2801.

3. McGowan J.V., Chung R., Maulik A., Piotrowska I., Walker J.M., Yellon D.M. Anthracycline Chemotherapy and Cardiotoxicity. Cardiovasc Drugs Ther, 2017, vol. 31, no. 1, pp. 63-75.

4. Petrova E.B., Statkevich T.V., Ponomarenco I.N., Mitkovskaya N.P. Postinfarktnoye remodelirovaniye levogo zheludochka: nekotoryye patogeneticheskiye aspekty [Left ventricular remodeling due to myocardial infarction: some patogenetic aspects]. Voennaya medizina, 2015, no 1, pp. 116-122. (in Russian).

5. Stachowiak P., Wojtarowicz A., Milchert-Leszczyńska M., Safranow K., Falco M., Kaliszczak R., Kornacewicz-Jach Z. The paradox of the first cycle of chemotherapy – transient improvement of contractility and diastolic function after the first cycle of anthracycline-based chemotherapy: a prospective clinical trial. Oncotarget, 2017, vol. 8, no. 56, pp. 96442-96452.

6. Kononchuk N.B., Mitkovskaya N.P., Abramova E.S., Shapoval E.V., Kononchuk S.N. Kardiotoksichnost', induzirovannaya chimioterapiey raka molochnoy zhelezy: faktory riska, patogenez [Cardiotoxicity induced by chemotherapy for breast cancer: risk factors, pathogenesis]. Medizinskiy zhurnal, 2013, no. 3(45), pp. 4-7. (in Russian).

7. Fajardo L.F. The pathology of ionizing radiation as defined by morphologic patterns. Acta Oncol. 2005, vol. 44, no. 1, pp. 13-22.

8. Khurs E.M., Poddubnaya A.V. Echokardiografiya v diagnostike strukturno-funkzional'nogo sostoyaniya i remodelirovaniya serdza [Echocardiography in the Diagnosis of a Structural and Functional Cardiac State and Cardiac Remodeling]. Ul'trazvukovaya i funkzional'naya diagnostika, 2010, no. 1, pp. 89-100. (in Russian).

9. Plana J.C., Galderisi M., Barac A., Ewer M.S., Ky B., Scherrer-Crosbie M., Ganame J., Sebag I.A., Agler D.A., Badano L.P., Banchs J., Cardinale D., Carver J., Cerqueira M., DeCara J.M., Edvardsen T., Flamm S.D., Force T., Griffin B.P., Jerusalem G., Liu J.E., Magalhães A., Marwick T., Sanchez L.Y., Sicari R., Villarraga H.R., Lancellotti P. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2014, vol. 15, no. 10, pp. 1063-1093. doi: 10.1093/ehjci/jeu192.

10. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F.3rd, Dokainish H., Edvardsen T., Flachskampf F.A., Gillebert T.C., Klein A.L., Lancellotti P., Marino P., Oh J.K., Popescu B.A., Waggoner A.D. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 2016, vol. 29, no. 4, pp. 277-314.

11. Rayding E. Echokardiografiya : prakticheskoe rukovodstvo [Echocardiography: practical manual] : per. s angl. 3-e izd. M. : MEDpress-inform, 2013. 280 s. (in Russian).

12. Mitkovskaya, N.P., Grigorenko E.A., Danilova L.I. Serdze i metabolicheskiy risk [Heart and Metabolic Risk]. Minsk : Belorus. Nauka, 2008, 284 p. (in Russian).