Abstract PO5-26-03: Evaluation of cardiotoxicity in Mexican patients with Breast Cancer under neoadjuvant treatment by two-dimension speckle echocardiography
Authors: Williams-Sanchez Haydee , Espinosa-Fernandez Jose Rodrigo , Ruiz-Cruz Sandy , Velazquez-Martinez Areli , Espinola-Zavaleta Nilda , Guerra Enrique C. , Aparicio-Ortiz Alexis D , Cabello-Ganem Aldo , Luna-Alcalá Santiago , Proaño-Bernal Leonardo , Antonio-Villa Neftali Eduardo 
Published: May 2024

Background

Cardiotoxicity is a major concern in breast cancer patients treated with anthracyclines or anti-HER-2 therapy. The assessment of left ventricular ejection fraction (LVEF) by transthoracic echocardiogram (TTE) has been the most common method to evaluate cardiotoxicity. Different TTE parameters have been studied to assess cardiotoxicity, we aimed to evaluate left atrial strain (LAS) as a parameter of diastolic cardiotoxicity in Mexican patients under neoadjuvant treatment.

Methods

We prospectively recruited patients with breast cancer under neoadjuvant treatment with anthracyclines and/or anti-HER-2 from March 2022 to present. The evaluation includes TTE, and troponin measurements before chemotherapy, and respective follow-ups at 3 and 6 months from the baseline. We enrolled 187 patients, 172 and 131 had completed the three and six-month follow-ups, respectively. We limited the analysis to patients we could assess cardiotoxicity status, defined according to the ESC 2022 guidelines. Clinical and echocardiographic parameters were compared according to cardiotoxicity status using Chi-squared, two-tailed t-tests or Wilcoxon tests, as appropriate.

Results

The mean time of follow-up at second assessment was 213 days. The patients are divided into cardiotoxicity and no cardiotoxicity group. We reported 81 events of cardiotoxicity if we include troponin measurement or 36 events if we only evaluate TTE measurements. The incidence of cardiotoxicity in this study was not related with common risk factors as high BMI, presence of hypertension/diabetes or smoking status, but it was statistically associated with the presence of elevated LDL cholesterol (p 0.026). Fourteen percent (14%) were HR-/HER-2 (+), 44% HR+/HER-2 (-), 25% HR+/HER-2 (+), and 17% triple negative subtype. Eightyfive percent (85%) of patients received anthracyclines, 28% in combination with anti-HER-2 treatment, 12% received double anti-HER-2 blockade anthracycline free. The accumulated dose of anthracycline didn’t differ between groups. The use of anthracyclines and double anti/HER blockade was statically associated with development of CTRCD (p &lt; 0.01 and p &lt; 0.01), respectively, but not with a single anti-HER-2 treatment.

In troponin-based cardiotoxicity definition, at the three-month follow-up, those who developed cancer therapy-related cardiac dysfunction (CTRCD) had only statically significant lower LVEF (Table 1) with respect to basal assessment. LASr baseline, three months and six months was similar between groups. In the cardiotoxicity group without troponin measurement, we observed statically significant decreased LVEF and LV GLS at 3 months and six months, and tendency to decreased LASr with respect to basal evaluation.

Conclusions

In our cohort the only modifiable risk factor with impact in the development of CTRCD was dyslipidemia, specifically high LDL. The traditional chemotherapy schemas as anthracyclines and doble anti HER-2 blockade correlate with the development of cardiotoxicity, but not the use of anti-HER-2 as single agent. The addition of troponin measurement to cardiotoxicity definition detected a greater number of events in this study, but doesn’t reflect changes in ETT parameters as LV- GLS and LVEF at this time of follow up, which means structural changes induced by treatment take time and serological measurement of troponin can enhance sensitivity and allows early detection. Further follow up and ETT assessment are needed.

Table 1. Cardiotoxicity events including or not troponin levels and TTE parameters.

Citation Format: Haydee Williams-Sanchez, Jose Rodrigo Espinosa-Fernandez, Sandy Ruiz-Cruz, Areli Velazquez-Martinez, Nilda Espinola-Zavaleta, Enrique C. Guerra, Alexis D Aparicio-Ortiz, Aldo Cabello-Ganem, Santiago Luna-Alcalá, Leonardo Proaño-Bernal, Neftali Eduardo Antonio-Villa. Evaluation of cardiotoxicity in Mexican patients with Breast Cancer under neoadjuvant treatment by two-dimension speckle echocardiography [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-03.