Systemic HypertensionSystemic Hypertension2075-082X2542-2189Intermedservice Ltd2958110.26442/2075-082X_14.3.21-27Research ArticleMarkers of early cardiotoxicity in patients with breast cancer undergoing chemotherapy depending on blood pressure levelAvalyanA Aani_avalian@mail.ruKirillovaM Yu-ShitovV N-OshchepkovaYe V-SaidovaM A-SteninaM B-ChazovaI Ye-A.L.Myasnikov Institute of Clinical Cardiology National Research Medical Center of Cardiology of the Ministry of Health of the Russian FederationN.N.Blokhin National Research Medical Center of Oncology of the Ministry of Health of the Russian Federation15122017143212709042020Copyright © 2017, Consilium Medicum2017Objective. To study the possibility of the 2D Speckle Tracking Imaging in early detection of cardiotoxicity in patients with triple negative breast cancer and arterial hypertension (AH) during anthracycline-containing chemotherapy. Materials and methods. 70 women (mean age 48.6±13.3 years) with triple negative breast cancer were enrolled. All patients underwent chemotherapy, including anthracycline, taxan, platinum-based agent. Echocardiography, including 2D Speckle Tracking Imaging, was performed on Vivid-E 9 ultrasound machine before and after 8 weeks of chemotherapy. Left ventricular ejection fraction (LVEF) (the biplane Simpson`s method) and global longitudinal strain (GLS) (mean normal GLS of -22.1±1.8 for women) were analysed. Patients were divided into two groups: group 1 - with AH (n=18) and group 2 - with normal blood pressure (n=52). Results. Before chemotherapy in group 1 GLS was lower than normal value (-19.1±2.8% vs -22.1±1.8%; p<0.05) and lower than in the group 2 (-19.1±2.8% vs -20.0±2.8%; p>0.05). After chemotherapy in all patients GLS decrease was observed from -20.0±2.8% to -18.5±2.9% (p<0.05) and in group 1 from -19.1±2.8% to -16.4±3.8% (р<0.05), group 2 from -20.0±2.8% to -19.2±2.4% (p<0.05). However LVEF remained within normal values. The values of GLS decreased by more than 15% in 12 (17%) of all the patients. Conclusions. Apparently, GLS is the one of most sensitive early marker of chemotherapy - induced cardiotoxicity compared with the LVEF.cardio-oncologyarterial hypertensioncardiotoxicityglobal longitudinal strain of the left ventriclechemotherapybreast cancerкардиоонкологияартериальная гипертониякардиотоксичностьглобальный продольный стрейн левого желудочкахимиотерапиярак молочной железы[Brana I, Tabernero J. Cardiotoxicity. Ann Oncol 2010; 21: 173-9.][Gillespie H.S, McGann C.J, Wilson B.D. Noninvasive diagnosis of chemotherapy related cardiotoxicity. Curr Cardiol Rev 2011; 7: 234-44.][Jensen B.V. Cardiotoxic consequences of anthracyline-containing therapy in patients with breast cancer. Semin Oncol 2006; 33: 15-21.][Doyle J.J, Neugut A.I, Jacobson J.S. et al. Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol 2005; 23: 8597-605.][Hooning M.J, Botma A, Aleman B.M. et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 2007; 99: 365-75.][Корнеева О.Н., Драпкина О.М., Козлова Е.В. и др. Кардиомиопатия, индуцированная полихимиотерапией, у больных раком молочной железы. Клиницист. 2011; 3: 109-11.][Шуйкова К.В., Емелина Е.И., Гендлин Г.Е. и др. Кардиотоксичность современных химиотерапевтических препаратов. АтмосферA. Новости кардиологии. 2012; 3: 9-19][Cardinale D, Colombo A, Lamantia G et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. JACC 2010; 55 (3): 213-20.][Чазова И.Е., Ощепкова Е.В., Кириллова М.Ю. и др. Риск развития артериальной гипертонии у пациентов с онкологическими заболеваниями на фоне противоопухолевого лечения. Consilium Medicum. 2016; 18 (1): 16-20][Чазова И.Е., Ощепкова Е.В., Кириллова М.Ю. и др. Сердечно-сосудистые и онкологические заболевания: поиск решений новых проблем. Системные гипертензии. 2015; 12 (2): 6-7][Sadurska E. Current Views on Anthracycline Cardiotoxicity in Childhood Cancer Survivors. Pediatr Cardiol 2015; 36: 1112-9.][ВОЗ. URL: http://www.who.int/ru/ / VOZ. URL: http://www.who.int/ru/ [in Russian]][Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10: 4-12.][Piccirillo J.F, Tierney R.M, Costas I et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004; 291 (20): 2441-7.][Шарипова Г.Х., Саидова М.А., Жернакова Ю.В., Чазова И.Е. Влияние метаболического синдрома у больных артериальной гипертонией. Альманах клинической медицины. 2015; 1 (Спецвып.): 102-10][Erika Matos , Borut Jug, Rok Blagus et al. A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients. Arq Bras Cardiol 2016; 107 (1): 40-47.][Robin K. Kuriakose, Rakesh C. Kukreja, and Lei Xi Potential. Therapeutic Strategies for Hypertension-Exacerbated Cardiotoxicity of Anticancer Drugs. Oxid Med Cell Longev 2016; Article ID 8139861; 9.][Bovelli D, Plataniotis G, Roila F. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Ann Oncol 2010; 21 (Suppl. 5): 277-82.][Seidman A, Hudis C, Pierri M.K. et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 2002; 20: 1215-21.][Daher I.N, Kim C, Saleh R.R. et al. Prevalence of abnormal echocardiographic findings in cancer patients: a retrospective evaluation of echocardiography for identifying cardiac abnormalities in cancer patients. Echocardiography 2011; 28: 1061-7.][Plana J.C, Galderisi M, Barac A et al. Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2014; 27: 911-39.][Mondillo S, Galderisi M, Mele D. et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med 2011; 30: 71-8.][Zamorano J.L, Lancellotti P, Rodriguez Muñoz D et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; August 26: 1-34. doi:10.1093/eurheartj/ehw211][Lenihan D.J, Kowey P.R. Overview and management of cardiac adverse events associated with tyrosine kinase inhibitors. Oncologist 2013; 18: 900-8.][Васюк Ю.А., Школьник Е.Л. и др. Антрациклиновая кардиотоксичность: перспективы использования ивабрадина. Кардиосоматика. 2012; 3 (4): 65-9.][Mouhayar E, Salahudeen A. Hypertension in cancer patients. Tex Heart Inst J 2011; 38 (3): 263-5.][Crawford S.C. Acute Chemotherapy-Induced Cardiovascular Changes in Patients With Testicular Cancer: Are There Implications for Blood Pressure Management in Patients Receiving Chemotherapy? J Clin Oncol 2006; 24 (15): 2399-400.][Radwan H, Hussein E. Value of global longitudinal strain by two dimensional speckle tracking echocardiography in predicting coronary artery disease severity. Egypt Heart J 2017; 69: 95-101.][Stoodley P.W, Richards D.A, Boyd A. et al. Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy. Eur Heart J Cardiovasc Imaging 2013; 14 (3): 228-34.][Portugal G, Moura Branco L, Galrinho A. et al. Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity. Rev Port Cardiol 2017; 36 (1): 9-15.][Boyd A, Stoodley P, Richards D. et al. Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study. PLoS One 2017; 12 (4): e0175544; 15.][Fraeman K.H, Nordstrom B.L, Luo W. et al. Incidence of New-Onset Hypertension in Cancer Patients: A Retrospective Cohort Study. Int J Hypertens 2013. Article ID 379252; 10.]