Detecção precoce da disfunção ventricular esquerda no tratamento quimioterápico do câncer de mama

• Autor(a) principal: Barroso, Geanne Maria Holanda de Menezes
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/13058
• topic: Cardiotoxicidade; Disfunção ventricular; Câncer de mama; Ecocardiografia; Cardiotoxicity; Ventricular dysfunction; Breast cancer; Echocardiography; Strain; CIENCIAS DA SAUDE

Background: The chemotherapy treatment of breast cancer is associated with left ventricular dysfunction, known as cardiotoxicity. Early diagnosis of cardiotoxicity and its treatment increase the survival of patients. The low sensibility of the ejection fraction by two-dimensional echocardiography makes it mandatory to evaluate the systolic function by three-dimensional echocardiography and Global Longitudinal Strain. Objectives: Assess the frequency of early left ventricular systolic dysfunction in patients with breast cancer treated with anthracycline associated or not with trastuzumab. Methodology: This is an observational, longitudinal, analytical and prospective study with a consecutive sample of 66 patients, mean age of 50.1 ± 11.7 years, submitted to four echocardiograms: before chemotherapy, with 30 days, three and six months. The conventional parameters of left ventricular systolic and diastolic function besides right ventricular systolic function were measured. The left ventricular systolic dysfunction was diagnosed when reduction of the biplanar or threedimensional ejection fraction > 10% to <53%, or reduction of the Global Longitudinal Strain > 15%. Results: At 30 days, the left ventricular systolic dysfunction occurred in 17 of 66 patients or 25.8% (CI, 16.7 to 33.3). At 3 months in 17 of 63 patients or 27% (CI, 17.5 to 36.5) and at 6 months in 18 of 53 or 34% (CI, 22.6 to 45.3). The Global Longitudinal Strain was a predictor of systolic dysfunction with reduction of 10%. The diastolic dysfunction was also present; in 30 of the 66 patients or 45% (CI, 33.54,6) in the baseline period, in 31 of the 66 patients or 47% at 30 days (CI, 34.9 to 56.1), in 35 of the 63 patients or 55% at 3 months (CI, 42.9 to 65.1) and in 29 of the 53 patients or 54% (CI, 39.6 to 66) at 6 months. There was no right ventricular systolic dysfunction. Conclusion: Treatment with anthracycline is related to left ventricular systolic and diastolic dysfunction. The frequency of systolic dysfunction was high, earlier than diastolic dysfunction, occurred starting at 30 days and remained highed until six months, and the Global Longitudinal Strain was the most sensitive parameter.