Does epirubicin affect left ventricular systolic performance in oncologic patients?

PURPOSE

In the present study the left ventricular diastolic and systolic functions were evaluated in patients treated with lower total doses of epirubicin using Doppler echocardiography.

PATIENTS AND METHODS

Seventeen patients with different malignant tumors treated with epirubicin up to 450 mg/m(2) (study group), and a gender-and age-matched group of 29 patients diagnosed with tumors, who had not started treatment yet (control group), were assessed by echocardiography. Left ventricular diastolic function was assessed by measuring the Doppler transmitral flow. We measured the maximal velocity of the E wave (rapid filling) and A wave (atrial filling). The ratio of Emax/Amax, the pressure half time (PHT) of the E wave and the iso-volumic relaxation time (IVRT) were also calculated. The left ventricular systolic performance was assessed by measuring the global ejection fraction (EF).

RESULTS

The left ventricular diastolic performance was altered in the study group. In this group we noticed a significant decrease ( p < 0.001) of Emax. A wave was significantly increased in the study group compared to the control group ( p < 0.001). The mitral E/A ratio was subunitary in the study group. The E wave PHT was prolonged in the epirubicin-treated group in comparison to the controls (p<0.001). The IVRT was prolonged in the study group in comparison to the controls (p<0.05). The left ventricular systolic performance was not significantly altered in the study group compared to the control group. Although the EF was lower in the study group the difference did not reach statistical significance.

CONCLUSION

Our Doppler echocardiography study documented an impaired left ventricular diastolic performance in patients with various malignancies treated with lower total doses of epirubicin. This impairment is due to poor left ventricular compliance.