P701Complex changes in atrial function assessed by speckle tracking after epirubicin-based chemotherapy in patients with breast cancer


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Abstract

Subclinical impairment of LV longitudinal deformation in patients with breast cancer, treated with epirubicin, was demonstrated previously (also by our work), but data on left atrial (LA) function are lacking. Therefore, we investigated changes in LA function during epirubicin-based chemotherapy, and its relation with LV function.Methods: 35 women with breast cancer (59±4 years), without known cardiac disease, EF>60%, were assessed at baseline, and after 6 cycles of epirubicin. LA function (long-axis deformation and rate of deformation) was assessed, by 2D speckle tracking, from peak negative strain (PNS) and strain rate (PNSR); peak positive strain (PPS) and strain rate (PPSR); global strain (PNS+PPS - GS); and the duration of the LA phases - pump phase (from P wave onset to the PNS - LAPPD), reservoir phase (from R wave peak to the PPS – LARPD), and passive conduct phase (from PPS to P wave onset – LAPCP); LA volume was also measured. LV function was assessed from volumes, EF, longitudinal deformation (LS), for systole; and E, E/A, E/Vp, and E/E' ratios, for diastole.Results: After the 6th cycle of epirubicin there were no changes of LV or LA volumes or EF; there was a decrease of LV LS (-24.3±2.7 vs -20.5±2.5%), and of LV diastolic function (E=110.4±14.1 vs 91.2±13.0 cm/s; E/A=1.14±0.32 vs 0.93±0.24; E/Vp=1.5±0.5 vs 2.1±0.9; E/E'=4.3±1.2 vs 6.2±2.1)(all p<0.05). Meanwhile, there were changes in LA pump phase (significant reductions in PNS, PNSR, and in GS, and increase of LAPPD), no changes in LA reservoir phase, and increase of passive conduit phase duration (table). Univariate analysis showed that LA GS was correlated with E, E', and LS (r=0.59; r=0.54; and r=0.72), and E/E' ratio (r=- 0.63)(all p<0.05). By multiple stepwise regression analysis, best independent determinant of GS was LS (r=0.66, r2= 0.42, p<0.01).Conclusion: Intrinsic LA function, assessed by speckle tracking, is impaired by epirubicin in patients with breast cancer, in parallel and in relation with longitudinal LV systolic deformation, and should be also monitored during epirubicin-based chemotherapy.

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