Early Diagnosis of Cardiac Toxicity Related to Antineoplastic Treatment (Clinical Report‪)‬

1. Introduction Cancer treatment actually is a combination of surgery associated to chemotherapy [1] and radiotherapy [2] to prolong life duration and quality. Unfortunately this combination can cause cardiotoxicity, it can precociously on set but also arise after many years from therapy interruption [3] Many different chemotherapeutic agents can determine cardiovascular complications such as heart failure for left ventricular function impairment, all kinds of coronary artery diseases and, at a lower rate, thromboembolism, and arrhythmias [4]. The same happens for radiotherapy because of mediastinal irradiation [5]. It is important to early recognize cardiotoxicity onset because of its significant impact on the cardiac function and survival of cancer patients. To assess LV function, a base line evaluation of LV ejection fraction (EF) is always obtained, before chemo and/or radio therapy start, and it is recommended that the same methodology be used for serial assessment [6] It was first established in clinical practice since 1979 [7], based on their experiences, algorithms have been developed for serial monitoring of LVEF during chemiotherapy [8,9]. Measuring systolic function through evaluation of the LVEF with echocardiography is one of the most commonly used measurements in monitoring and diagnosing chemotherapy-induced cardiomyopathy; however, it is not sensitive for early detection of pre-clinical cardiac disease (subclinical), and it is influenced by contractility and pre-load /afterload effects leading to transient changes. Therefore, other measurements of LV function (e.g., E/A ratio) have been used to detect early cardiotoxicity in addition to Early Diagnosis of Cardiac Toxicity Related to Antineoplastic Treatment LVEF [10]. Due to an increasing aging population of patients with cancer and the introduction of many new cancer therapies, breast cancer often occurs on women just affected by hypertension and/or diabetes [11] All these conditions may affect left ventricular (LV) geometry, mass and diastolic function, but in what proportion it is unknown. Early detection of these conditions may contribute to improve heart failure prevention. The purpose of our study was to determine the prevalence of left ventricular changes of geometry, mass and diastolic dysfunction on a population of women affected by breast cancer, submitted to radiotherapy and chemotherapy, who present preserved LVEF.