ECG and Echocardiographic Signs of Early Onset of Cardiotoxic Effects in Patients with Breast Cancer after Chemoradiotherapy

Abstract

<h3>Purpose/Objective(s)</h3> In the broad context of preventive and personalized medicine, in this study we aim to detect early predictive biomarkers of impaired heart function in patients with HER2 positive breast cancer undergoing multi-modal treatments in our institution. <h3>Materials/Methods</h3> Our study group contains 45 positive HER2 patients aged between 30 and 78 years (median age 51 years, mean age 52.2 years) with breast cancer who in the period 2015-2020 underwent multimodal chemotherapy treatments with anthracyclines, treatment surgery, targeted anti-HER2 treatment and radiation therapy (in different modes 2D, 3D and VMAT). During therapy, cardiac function was monitored by echocardiography (ECO) and ECG at regular intervals, which allowed evaluation before, during, and at the end of each stage of treatment. By calculating the risk estimates (odds- and risks ratios) and by building multivariate logistic models we evaluated the associations between the average dose, the maximum dose, V25, V30 corresponding to the whole heart, left ventricle and various arterial routes of coronary circulation, on the one hand and echocardiographic and electrocardiographic semiology in the interval 18-36 months after the start of multimodal treatment. The logistic models allowed us to discriminate both the short-term cardiotoxic effects of the other therapies and the individual effects of radiotherapy, but also to obtain correlative effects of the effects of radiotherapy in relation with the hormonal profile of the tumor, anthracycline dose history, time spacing the onset of other therapies, etc. <h3>Results</h3> Our studied shows that, as a general rule, there is an association between changing ECG semiology (by exacerbating pre-existing pathologies and / or by the appearance of new abnormalities) and the dose delivered both to the heart, the left ventricle in particular and the coronary arteries (except the right coronary arteries, RCA). The effect of the delivered dose on the RCA is associated with changes in echocardiographic semiology. <h3>Conclusion</h3> By estimating the risk relations between dose thresholds and early cardiotoxic effects, this study is the premise of reviewing the current protocols for cardiac monitoring and also for the need to the use high-performance instruments aiming to build predictive tools for the early onset of radiotherapy-related cardiac pathologies.