Clinical & Experimental Cardiology
Open Access

Abstract

Prevalence and Predictors of Worsening of Diastolic Function in Cancer Patients with Normal Baseline Ejection Fraction undergoing Chemotherapy

Antoine Abchee, Hadi Skouri, Stephanie Matta, Lara El-Masri, Chadi Alraies and Wael A AlJaroudi

Purpose: Chemotherapeutic agents such as anthracyclines and monoclonal antibodies Tyrosine Kinase Inhibitors (TKI) have been associated with systolic and Diastolic Dysfunction (DD). Data from the Middle Eastern region is lacking, and disparities in response to therapy and toxicity profile have been observed among different racial and ethnic groups. We hypothesized that worsening diastolic function proceeded systolic dysfunction among Middle Eastern patients with normal baseline echocardiogram receiving chemotherapy, and sought to assess its incidence and independent predictors.

Methods: Consecutive outpatients presenting for baseline echocardiogram prior to chemotherapy were prospectively enrolled between 7/2013 and 6/2014. Patients with EF <50%, severe valvular disease, or atrial fibrillation were excluded. Diastolic function was graded blindly according to the guidelines by two level III certified cardiologists.

Results: There were 226 patients (age 49.5 ± 14.3 years, 78% female) with LVEF and GLS 59.8 ± 3.9% and -19.8 ± 2.3%, respectively; 135 (59.7%) had normal diastolic function, 82 (36.3%) grade I, and 9 (4%) grade 2 DD. After a mean follow-up time of 93 ± 45 days, 81 patients presented for repeat echocardiogram. There were 49/226 patients (entire cohort) and 35/81 (follow-up) that received anthracyclines or TKI. On follow-up imaging, 14 patients (17.3%) had worsening diastolic function without change in EF; they were all female with breast cancer. On multivariate regression analysis, old age, increased BMI, anthracyclines or TKI, and No ACEi/ARB were independent predictors of worsening diastolic function, while beta-blockers were associated with improved function.

Conclusion: In Middle Eastern patients undergoing chemotherapy, mainly female with breast cancer, worsening diastolic function is not uncommon and could be an early marker of cardiomyopathy. Old age, obesity, anthracyclines or TKI regimens are associated with increased risk, while ACEi/ARB and beta-blockers seems protective. These results should be interpreted with caution given the small sample size, and endpoints limited to female with breast cancer. Larger validation studies are needed.