CARDIOTOXICITY IN PATIENTS WITH TRIPLE NEGATIVE BREAST CANCER UNDERGOING ANTHRACYCLINE CHEMOTHERAPY DEPENDING ON BLOOD PRESSURE LEVEL

Abstract

Objective: to study the risk of cardiotoxicity in patients with triple negative breast cancer with arterial hypertension (AH) during anthracycline chemotherapy. Design and method: 70 women [48.6 ± 13.3 yrs] with breast cancer were enrolled. In all patients office blood pleasure (BP) was thrice measured. Echocardiography, including 2D STE, was performed before and after 8 courses of antitumor therapy. Left ventricular ejection fraction (LVEF) measured with the biplane Simpson's method and global longitudinal strain (GLS) [normal GLS – 22.1 ± 1.8 for women] were analyzed. Patients depending on blood pressure level were divided into 2 groups: group 1 - with AH (n = 18) and group 2 – without AH (n = 52). Results: The average level of office BP in group 1 was 130.8 ± 2.3 / 79.5 ± 2.7 mm Hg. After chemotherapy target BP level was maintained in 10 patients. There was a significant LVEF reduction after chemotherapy (from 68.9 ± 5.8% to 63.7 ± 6.7%, p < 0.05). Initially in group 1 GLS was lower than normal range (−19.1 ± 2.8%, p < 0.05), after chemotherapy further GLS decrease was recorded (from −19.1 ± 2.8% to −16.4 ± 3.8% [p < 0.05]). There was a further progression of AH (mean systolic BP (sBP) 162.2 ± 11.2 mmHg, mean diastolic BP (dBP) −98.3 ± 4.9 mmHg) in 8 patients (44.4%) in spite of antihypertensive therapy during chemotherapy. After chemotherapy reduction in LVEF was observed (from 65.9 ± 3.4% to 62.0 ± 2.0% (n.s.)). GLS before chemotherapy was below the normal values (−18.0 ± 1.5%), after chemotherapy GLS values were 15.6 ± 1.3% (n.s.). Also there was an increase in BP in 7 patients (13.4%) without initial AH during chemotherapy (mean sBP -148.3 ± 5.8 mmHg, mean dBP - 94.1 ± 3.7 mmHg). Before and after chemotherapy the LVEF was 68.9 ± 1.7% and 67.9 ± 1.5%, consequently. There were practically no changes in initially normal GLS before (21.8 ± 0.4%) and after chemotherapy GLS (21.4 ± 0.5%, (n.s)). Conclusions: Patients with AH already have a subclinical impairment in cardiac function, which makes them more vulnerable to cardiotoxic effects of chemotherapy.