Speckle-Tracking Echocardiography for Cardioncological Evaluation in Bevacizumab-Treated Colorectal Cancer Patients
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Speckle‑Tracking Echocardiography for Cardioncological Evaluation in Bevacizumab‑Treated Colorectal Cancer Patients Andrea Sonaglioni1 · Adriana Albini2 · Emanuela Fossile3 · Maria Adelaide Pessi3 · Gian Luigi Nicolosi4 · Michele Lombardo1 · Claudio Anzà5 · Giuseppe Ambrosio6
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Angiogenesis inhibitor Bevacizumab (BVZ) may lead to the development of adverse effects, including hypertension and cardiac ischemia. Whether assessment of changes in myocardial strain by two-dimensional speckle-tracking echocardiography (2D-STE) can be of value in detecting BVZ-mediated cardiotoxicity at an earlier stage is not known. We investigated whether 2D-STE can non-invasively detect early evidence of cardiotoxicity in metastatic colorectal cancer (mCRC) patients treated with BVZ. Between January and June 2019, 25 consecutive patients (71.8 ± 7.5 year/old, 17 males) with mCRC were prospectively enrolled. Patients underwent physical examination, blood tests, and conventional 2D-transthoracic echocardiography implemented with 2D-STE analysis, at baseline and at 3 and 6 months following treatment with BVZ (15 mg/kg every 15 days) + 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX i.v.). At 6-month follow-up, we assessed occurrence of global longitudinal strain (GLS) impairment (> 15% decrease in GLS compared with baseline) as primary end-point and a new-onset systemic hypertension (secondary end-point). On average, GLS showed a progressive significant impairment after BVZ, from − 17.4 ± 3.2% at baseline to − 16 ± 2.9% (p = 0.003) at 6-month follow-up; > 15% decrease in GLS (primary endpoint) was detected in 9 patients (36%). All other strain parameters remained unchanged. New-onset systemic hypertension (secondary end-point) was diagnosed in five patients (20%). No significant changes were observed in serial high-sensitivity cardiac troponin I measurements. No patient developed significant changes in LV size or LV ejection fraction; no case of clinically symptomatic HF was observed during BVZ-treatment. Measurement of GLS by 2D-STE analysis can effectively detect BVZ-mediated cardiotoxicity at an early stage. Keywords Speckle-tracking echocardiography · Bevacizumab · Cardiotoxicity · Cardio-oncology · Hypertension · Heart failure · Thrombosis Abbreviations 2D Two-dimensional AFI Automated function imaging Handling Editor: Vera Costa. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12012-020-09583-5) contains supplementary material, which is available to authorized users. * Adriana Albini [email protected] 1
Department of Cardiology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy
2
Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy
3
Department of Oncology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy
AUC Area under the curve AVC Aortic valve closure BP Blood pressure BSA Body surface area BVZ Bevacizumab CI Confidence interval CRP C-re
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