Assessment of diastolic dysfunction in cancer patients with chemotherapy

Oncologic pathology has a high prevalence worldwide, and it has been found that up to 57% of the population presents cardiotoxicity during antineoplastic treatment, so that the adequate assessment of cardiovascular risk and baseline alterations in the myofibril due to the presence of diastolic dysfunction become factors that can determine the presence or progression towards cardiotoxicity.

Currently, there are few echocardiographic parameters with predictive capacity of cardiotoxicity in oncologic patients under chemotherapy treatment.

The aim of the study was to assess diastolic dysfunction in patients under chemotherapy treatment at baseline and at 3-month follow-up.

A cohort study was performed, collecting patients sent by the hematology and oncology services to the echocardiography service, as part of the protocol for initiation of chemotherapy.

A total of 65 patients were collected, 64% of whom were female, with a median age of 55 years. The main cardiovascular risk factors were hypertension (24%) and smoking (16%).

The main oncological diagnosis was breast cancer in 38%, followed by multiple myeloma in 24% and leukemia in 12%, requiring various treatment schemes, among them anthracyclines in 33%, monoclonal antibodies in 27% and VEGF inhibitors in 15%, requiring up to 55% of the population the use of concomitant radiotherapy requiring a median of 40 Gy in up to 6 sessions.

Within the analysis of the demographic characteristics of systolic and diastolic function pre and post initiation of chemotherapy at 3-month assessment, significant differences were found with an increase in the values of IVRT 100 vs 110 (p 0.001), and PWCP 11 vs 12.3 (p 0.008), with a decrease in SLG -19 vs -18 (p 0.02) and a progression in diastolic dysfunction from not presenting it to a mild degree (p 0.002).

Subsequently, an analysis was performed based on the treatment used, mainly with anthracyclines, finding significant differences with an increase in IVRT values 101 vs 110 (p0.04), and LAVI 19.7 vs 22.8 (0.02), as well as a decrease in LVEF 61.4 vs 56 (0.003) and in the progression of diastolic dysfunction, from no diastolic dysfunction to a mild degree (p 0.003).

The patient undergoing chemotherapy treatment showed changes in diastolic function after 3 months of treatment, with a progression from no dysfunction to mild dysfunction, the main altered echocardiographic parameter being the isovolumetric relaxation time, classified as slow relaxation, which was also evidenced by the use of anthracyclines and monoclonal antibodies.