- Email: [email protected]
Left ventricular echocardiographic parameters as predictors of cardiotoxicity in Breast cancer patients with a left ventricular ejection fraction of 50–60% treated with anthracyclines
66
Echocardiography and imaging
237
Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study A. Altes 1,∗ , M. Sochala 2 , D. Attias 2 , J. Dreyfus 2 , Y. Bohbot 3 , M. Toledano 1 , L. Macron 2 , C. Renard 3 , G. Chadha 3 , A. Truffier 1 , R.A. Guerbaai 4 , P.V. Ennezat 5 , P. Graux 1 , C. Tribouilloy 3 , S. Maréchaux 1 1 Groupement des Hôpitaux de l’Institut Catholique de Lille, Lomme 2 Centre Cardiologique du Nord, Saint-Denis 3 Centre Hospitalier Universitaire d’Amiens, Amiens, France 4 Université de Basel, Basel, Switzerland 5 Centre Hospitalier Universitaire de Grenoble, Grenoble, France ∗ Corresponding author. E-mail address: [email protected] (A. Altes) Background Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS). Purpose To identify the factors associated with increased AT/ET. Methods The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were retrospectively analyzed in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography—Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients. Results In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r = 0.57, P < 0.0001), mean pressure gradient (MPG, r = 0.60, P < 0.0001), aortic valve area (AVA, r = −0.50, P < 0.0001) and CT-AVC score (r = 0.24, P <0.0001). An AT/ET ratio had a good accuracy to predict a Vmax ≥ 4 m/s, an MPG ≥ 40 mmHg, or an AVA ≤ 1.0 cm2 , with an optimal cut-off value of 0.34. Multivariate linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure (SBP), increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P < 0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P < 0.05) (Fig. 1). Conclusions AT/ET ratio is related to echocardiographic and CTAVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.09.139 150
Left ventricular echocardiographic parameters as predictors of cardiotoxicity in Breast cancer patients with a left ventricular ejection fraction of 50—60% treated with anthracyclines R. Benmalek ∗ , I. Krikez , A. Maaroufi , L. Azzouzi , R. Habbal Service de cardiologie, CHU Ibn Rochd, Casablanca, Maroc ∗ Corresponding author. E-mail address: [email protected] (R. Benmalek) Introduction Anthracyclines are the gold standard adjuvant therapy for breast cancer patients but their use is limited by dosedependent often irreversible cardiotoxicity. Purpose To evaluate the interest of baseline echocardiographic parameters of left ventricular (LV) size and function to identify anthracycline-treated patients at high risk to develop cardiotoxicity in patients with low normal LV ejection fraction (LVEF). Methods We conducted a prospective longitudinal study in the cardio-oncology unit of Casablanca, the first cardio-oncology unit in Morocco. All the patients underwent echocardiography for preanthracycline assessment. LV volumes, LVEF, and peak longitudinal strain (GLS) were measured. Individuals were followed for cardiotoxicity and all-cause mortality over 23 months (from January 2017 to November 2018) Results Of 971 patients, 522 (56,7%) had a resting LVEF of 50—60%. Average LVEF was 55 ± 2%, global longitudinal strain (GLS) was −18.4 ± 3.2% and LV end-diastolic volume (LVEDV) was 108 ± 17 mL. Twenty six patients (4,9%) presented cardiotoxicity: congestive heart failure (HF) in 19 patients, arterial hypertension in 1 patient, 2 pericardial effusion, 2 cases of arrhythmias, 1 case of 3rd degree atrioventricular block and 1 right ventricular dysfunction. Age, diabetes, obesity, GLS and LVEDV were all predictive of MACE (P = 0.028, 0.017, 0.041, 0,038 and 0.014 respectively). Age and GLS were also predictive of overall mortality (P = 0.021 and 0.003 respectively). Conclusion In patients treated with anthracyclines with an LVEF of 50-60%, both baseline EDV and GLS predict the development of cardiotoxicity. These results may enable select patients at higher risk of cardiotoxicity and thus initiate early cardioprotective medical therapy and a closer cardiac surveillance. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.140 247
Trastuzumab chemotherapy subclinical cardiotoxicity in patients with breast cancer: A two-dimensional speckle tracking echocardiography study S. Charfeddine 1 , H. Sarray 1,∗ , W. Ben Kridis 2 , S. Sghaier 2 , A. Bahloul 1 , T. Ellouz 1 , Y. Kammoun 1 , R. Hammami 1 , L. Abid 1 , S. Kamoun 1 1 Service de Cardiologie, Hôpital Hedi-Chaker 2 Carcinologie, Hôpital Hedi-Chaker Sfax, Tunisie ∗ Corresponding author. E-mail address: [email protected] (H. Sarray) Fig. 1
Assessment of AT/ET ratio.
Introduction Trastuzumab chemotherapy has been associated with left ventricular (LV) dysfunction. We aimed to assess early changes in LV and right ventricular (RV) mechanics associated with trastuzumab treatment for breast cancer. As well as explore
Echocardiography and imaging
237
Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study A. Altes 1,∗ , M. Sochala 2 , D. Attias 2 , J. Dreyfus 2 , Y. Bohbot 3 , M. Toledano 1 , L. Macron 2 , C. Renard 3 , G. Chadha 3 , A. Truffier 1 , R.A. Guerbaai 4 , P.V. Ennezat 5 , P. Graux 1 , C. Tribouilloy 3 , S. Maréchaux 1 1 Groupement des Hôpitaux de l’Institut Catholique de Lille, Lomme 2 Centre Cardiologique du Nord, Saint-Denis 3 Centre Hospitalier Universitaire d’Amiens, Amiens, France 4 Université de Basel, Basel, Switzerland 5 Centre Hospitalier Universitaire de Grenoble, Grenoble, France ∗ Corresponding author. E-mail address: [email protected] (A. Altes) Background Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS). Purpose To identify the factors associated with increased AT/ET. Methods The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were retrospectively analyzed in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography—Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients. Results In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r = 0.57, P < 0.0001), mean pressure gradient (MPG, r = 0.60, P < 0.0001), aortic valve area (AVA, r = −0.50, P < 0.0001) and CT-AVC score (r = 0.24, P <0.0001). An AT/ET ratio had a good accuracy to predict a Vmax ≥ 4 m/s, an MPG ≥ 40 mmHg, or an AVA ≤ 1.0 cm2 , with an optimal cut-off value of 0.34. Multivariate linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure (SBP), increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P < 0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P < 0.05) (Fig. 1). Conclusions AT/ET ratio is related to echocardiographic and CTAVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.09.139 150
Left ventricular echocardiographic parameters as predictors of cardiotoxicity in Breast cancer patients with a left ventricular ejection fraction of 50—60% treated with anthracyclines R. Benmalek ∗ , I. Krikez , A. Maaroufi , L. Azzouzi , R. Habbal Service de cardiologie, CHU Ibn Rochd, Casablanca, Maroc ∗ Corresponding author. E-mail address: [email protected] (R. Benmalek) Introduction Anthracyclines are the gold standard adjuvant therapy for breast cancer patients but their use is limited by dosedependent often irreversible cardiotoxicity. Purpose To evaluate the interest of baseline echocardiographic parameters of left ventricular (LV) size and function to identify anthracycline-treated patients at high risk to develop cardiotoxicity in patients with low normal LV ejection fraction (LVEF). Methods We conducted a prospective longitudinal study in the cardio-oncology unit of Casablanca, the first cardio-oncology unit in Morocco. All the patients underwent echocardiography for preanthracycline assessment. LV volumes, LVEF, and peak longitudinal strain (GLS) were measured. Individuals were followed for cardiotoxicity and all-cause mortality over 23 months (from January 2017 to November 2018) Results Of 971 patients, 522 (56,7%) had a resting LVEF of 50—60%. Average LVEF was 55 ± 2%, global longitudinal strain (GLS) was −18.4 ± 3.2% and LV end-diastolic volume (LVEDV) was 108 ± 17 mL. Twenty six patients (4,9%) presented cardiotoxicity: congestive heart failure (HF) in 19 patients, arterial hypertension in 1 patient, 2 pericardial effusion, 2 cases of arrhythmias, 1 case of 3rd degree atrioventricular block and 1 right ventricular dysfunction. Age, diabetes, obesity, GLS and LVEDV were all predictive of MACE (P = 0.028, 0.017, 0.041, 0,038 and 0.014 respectively). Age and GLS were also predictive of overall mortality (P = 0.021 and 0.003 respectively). Conclusion In patients treated with anthracyclines with an LVEF of 50-60%, both baseline EDV and GLS predict the development of cardiotoxicity. These results may enable select patients at higher risk of cardiotoxicity and thus initiate early cardioprotective medical therapy and a closer cardiac surveillance. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.140 247
Trastuzumab chemotherapy subclinical cardiotoxicity in patients with breast cancer: A two-dimensional speckle tracking echocardiography study S. Charfeddine 1 , H. Sarray 1,∗ , W. Ben Kridis 2 , S. Sghaier 2 , A. Bahloul 1 , T. Ellouz 1 , Y. Kammoun 1 , R. Hammami 1 , L. Abid 1 , S. Kamoun 1 1 Service de Cardiologie, Hôpital Hedi-Chaker 2 Carcinologie, Hôpital Hedi-Chaker Sfax, Tunisie ∗ Corresponding author. E-mail address: [email protected] (H. Sarray) Fig. 1
Assessment of AT/ET ratio.
Introduction Trastuzumab chemotherapy has been associated with left ventricular (LV) dysfunction. We aimed to assess early changes in LV and right ventricular (RV) mechanics associated with trastuzumab treatment for breast cancer. As well as explore