Disturbed diastolic cardiac function one year after cisplatin-based chemotherapy for testicular cancer

Abstract

5088 Background: Chemotherapy-induced cardiovascular effects are increasingly observed in testicular cancer (TC) survivors. Early signs of cardiovascular damage after cisplatin-based treatment are important to estimate subclinical cardiac dysfunction. We prospectively investigated changes in cardiac function within the first year after chemotherapy for disseminated TC. Methods: In TC patients (pts) treated at the University Medical Center Groningen we performed echocardiography before start of Bleomycin, Etoposide and Cisplatin chemotherapy and one year later. Systolic left ventricular function was estimated by Wall Motion Score Index (WMSI, normal =1.00); diastolic function by Tissue Velocity Index (TVI, available in 19 pts) and E/A ratio. Diastolic dysfunction was defined as TVI <8cm/s and/or E/A-ratio <1. Concomitantly cardiovascular risk factors (CRF) were assessed, including 24-hour ambulatory blood pressure (BP). Results: 42 TC pts (median age 28 years, range 18–50) were assessed pre- and post treatment. The median interval was 10 months (range 6–15). Diastolic dysfunction was present in 9 pts pre-treatment (E/A-ratio <1 n=7, TVI <8 n=1, both n=1), CRF in these 9 pts consisted of obesity (n=5) and hypertension (n=3). One year later pre-treatment diastolic dysfunction persisted in 5 pts, new dysfunction developed in 2 pts (E/A-ratio <1 n=4, TVI <8 n=2, both n=1). CRF in these 7 pts were hypercholesterolemia (n=2) and obesity (n=1). Compared with pre-treatment the median E/A ratio did not change (1.38 ± 0.46 Vs 1.35 ± 0.037; p=0.259), whereas median TVI decreased after treatment (12.0 ± 3.2 Vs 10.4 ± 2.9 cm/s; p=0.002). The median WMSI did not change (1.00 ± 0.04 Vs 1.00 ± 0.12; p=0.273). BP did not change (systolic 130 ± 11.6 Vs 122 ± 10.8; p=0.082; diastolic 74 ± 9.6 Vs 68 ± 11.4; p=0.140). Systolic BP and age correlated with TVI pre- and post treatment. Conclusions: One year after cisplatin-based treatment, TC-survivors have a significant decrease in TVI, suggesting an impaired diastolic function of the heart. Systolic parameters and BP did not change. The prognostic significance of this disturbed diastolic function 1 year after chemotherapy for future cardiovascular morbidity is not clear yet. No significant financial relationships to disclose.