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. 1999 Apr;81(4):419–423. doi: 10.1136/hrt.81.4.419

Early detection of anthracycline induced cardiotoxicity in asymptomatic patients with normal left ventricular systolic function: autonomic versus echocardiographic variables

G Tjeerdsma 1, M Meinardi 1, W T A van der Graaf 1, M P van den Berg 1, N Mulder 1, H Crijns 1, E G E de Vries 1, D J van Veldhuisen 1
PMCID: PMC1728986  PMID: 10092570

Abstract

OBJECTIVE—To investigate left ventricular dysfunction in patients who had been treated with anthracycline based chemotherapy.
METHODS—Autonomic function was compared with left ventricular diastolic function in 20 asymptomatic women with normal systolic function (left ventricular ejection fraction (LVEF) > 0.50) treated for breast cancer with high dose anthracycline based chemotherapy, and 20 age matched healthy controls. Left ventricular diastolic function was assessed echocardiographically by measuring the early peak flow velocity to atrial peak flow velocity ratio, isovolumic relaxation time, and deceleration time. Heart rate variability analysis was assessed for time domain and frequency domain parameters.
RESULTS—The mean (SD) age of the patients was 45 (7) years and the mean LVEF was 0.59 (0.06). The time interval after the end of chemotherapy was 29 (27) months. One or more diastolic variables were abnormal in 50% of the patients. Heart rate variability was abnormal in 85% of patients. Mean values of both time domain and frequency domain parameters were decreased (p < 0.05), in particular the parasympathetic indices.
CONCLUSIONS—Autonomic impairment occurs in a large proportion of asymptomatic patients with normal systolic left ventricular function after high dose anthracycline based chemotherapy. In particular, heart rate variability analysis may be a sensitive tool to identify the first signs of cardiotoxicity in these patients.

 Keywords: anthracycline; cardiotoxicity; heart rate variability; echocardiography; chemotherapy

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Figure 1  .

Figure 1  

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Impact on autonomic balance for patients (solid) v age matched healthy controls (open) (time domain HRV parameters). SDANN, standard deviation of the averages of normal RR intervals in all five minute segments of a complete 24 h recording; SDNN, standard deviation of all normal RR intervals. Error bars = SD.

Figure 2  .

Figure 2  

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Autonomic impairment after anthracycline treatment for patients with breast cancer (solid) v age matched healthy controls (open) (time domain HRV parameters). All parameters were significantly lower in patients. pNN50, percentage of differences between successive normal RR intervals greater than 50 ms; rMSSD, the square root of the mean of the squared differences between successive normal RR intervals. Error bars = SD. *p < 0.05.

Figure 3  .

Figure 3  

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Impact on autonomic balance for anthracycline treated patients with breast cancer (solid) v age matched controls (open) (frequency domain heart rate variability parameters). HF, high frequency; LF, low frequency; TP, total power. Error bars = SD. *p < 0.01.

Selected References

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