Early detection of anthracycline induced cardiotoxicity in asymptomatic patients with normal left ventricular systolic function: autonomic versus echocardiographic variables

Objective-To investigate left ventricular dysfunction in patients who had b een treated with anthracycline based chemotherapy. Methods-Autonomic function was compared with left ventricular diastolic fun ction in 20 asymptomatic women with normal systolic function (left ventricu lar ejection fraction (LVEF) > 0.50) treated for breast cancer with high do se anthracycline based chemotherapy, and 20 age matched healthy controls. L eft ventricular diastolic function was assessed echocardiographically by me asuring the early peak flow velocity to atrial peak flow velocity ratio, is ovolumic relaxation time, and deceleration time. Heart rate variability ana lysis was assessed for time domain and frequency domain parameters. Results-The mean (SD) age of the patients was 45 (7) years and the mean LVE F was 0.59 (0.06). The time interval after the end of chemotherapy was 29 ( 27) months. One or more diastolic variables were abnormal in 50% of the pat ients. Heart rate variability was abnormal in 85% of patients. Mean values of both time domain and frequency domain parameters were decreased (p < 0.0 5), in particular the parasympathetic indices. Conclusions-Autonomic impairment occurs in a large proportion of asymptomat ic patients with normal systolic left ventricular function after high dose anthracycline based chemotherapy. In particular, heart rate variability ana lysis may be a sensitive tool to identify the first signs of cardiotoxicity in these patients.