Combined NT–pro-BNP and CW-Doppler ultrasound cardiac output monitoring (USCOM) in epirubicin and liposomal doxorubicin therapy

Abstract

Background Chemotherapy with epirubicin is approved in women with breast cancer and is associated with a certain degree of cardiotoxicity. Hypothesis Epirubicin changes stroke volume, cardiac output and systemic vascular resistance, while liposomal doxorubicin does not. Methods 75 patients with HER-2-positive metastatic breast cancer were continuously measured with CW-Doppler ultrasound for stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) before, during and after drug infusion in combination with NT–pro-BNP before and 10 min after drug infusion. Results Epirubicin infusion increased stroke volume significantly in low-level NT–pro-BNP (62 ± 23 ml vs. 74 ± 29 ml, p = 0.004) and high-level NT–pro-BNP (48 ± 5 ml vs. 64 ± 20 ml, p = 0.131), while liposomal doxorubicin infusion increased stroke volume significantly in low-level NT–pro-BNP (54 ± 16 ml vs. 67 ± 22 ml, p = 0.001) and high-level NT–pro-BNP (65 ± 22 ml vs. 82 ± 27 ml, p = 0.001). Cardiac output was significantly increased in epirubicin ( p = 0.004) by 20% (NT–pro-BNP < 125 pg/ml) and not significantly 38% (NT–pro-BNP > 125 pg/ml; p = 0.144), while in liposomal doxorubicin cardiac output was significantly increased by 23% (NT–pro-BNP < 125 pg/ml; p = 0.023) and 33% (NT–pro-BNP > 125 pg/ml; p = 0.001). In liposomal doxorubicin cardiac index was significantly increased by 26% (NT–pro-BNP < 125 pg/ml; p = 0.021) and 33% (NT–pro-BNP > 125 pg/ml; p = 0.0001). SVR was significantly reduced during and after epirubicin therapy. Conclusion Using the CW-Doppler USCOM a different hemodynamic response to epirubicin vs. liposomal doxorubicin is evident. Epirubicin leads to a significant upregulation of stroke volume and cardiac output, which is even more pronounced in the high-level NT–pro-BNP group, while liposomal doxorubicin does not change immediate hemodynamics. No deterioration of cardiac function using the real-time CW-Doppler ultrasound USCOM or an increase in NT–pro-BNP levels was evident during epirubicin or liposomal doxorubicin therapy.