ABC | Volume 111, Nº5, November 2018

Original Article Arterial Stiffness Use for Early Monitoring of Cardiovascular Adverse Events due to Anthracycline Chemotherapy in Breast Cancer Patients. A Pilot Study Cláudio Antônio de Souza, 1,2 Ricardo Simões, 1,2,3 Karina Braga Gomes Borges, 3 Angélica Navarro de Oliveira, 1 Juliana Barroso Zogeib, 1 Bruno Alves, 1 Marcus Vinicius Bolívar Malachias, 1 Ana Paula Drummond-Lage, 1 Bruno Almeida Rezende 1,3 Faculdade de Ciências Médicas de Minas Gerais, 1 Belo Horizonte, MG – Brazil Hospital Alberto Cavalcanti, 2 Belo Horizonte, MG – Brazil Universidade Federal de Minas Gerais (UFMG), 3 Belo Horizonte, MG – Brazil Mailing Address: Bruno Almeida Rezende • Rua Clementino Viana Dotti, 162 apto 802. Postal Code 30575-139, Buritis, Belo Horizonte, MG – Brazil E-mail: bruno.rezende@cienciasmedicasmg.edu.br, brunorezende01@ yahoo.com.br Manuscript received February 20, 2018, revised manuscript May 08, 2018, accepted May 23, 2018 DOI: 10.5935/abc.20180168 Abstract Background: Chemotherapy with doxorubicin and cyclophosphamide, although efficient for treating breast cancer, is associated with cardiovascular complications. Recent studies seek to identify methods that can early detect cardiological and vascular changes as a strategy to decrease the incidence of cardiovascular comorbidities. Objective: To evaluate the role of arterial stiffness measurement in the monitoring of doxorubicin and cyclophosphamide- induced cardiotoxicity in breast cancer patients. Methods: Prospective longitudinal study in 24 breast cancer patients undergoing treatment with doxorubicin and cyclophosphamide. Patients underwent an indirect evaluation of arterial stiffness through non-invasive measurement of hemodynamic parameters such as pulse wave velocity with the Mobil-O-Graph® 24H PWA device at three different times of the chemotherapy treatment (pre-chemotherapy, after the first and the fourth cycle). The left ventricular ejection fraction was also evaluated by Doppler echocardiography (pre-chemotherapy and after the fourth chemotherapy cycle). Data were considered significant when p ≤ 0.05. Results: Patients had a mean age of 52.33 ± 8.85 years and body mass index of 31 ± 5.87 kg/m 2 . There was no significant difference between the hemodynamic parameters evaluated by the oscillometric method or in the left ventricular ejection fraction in the different evaluated periods. Conclusion: Evaluations of arterial stiffness by oscillometry and measurement of left ventricular ejection fraction by Doppler echocardiography showed equivalence in the values found, suggesting that the evaluation method of arterial stiffness studied could be used as a marker for cardiovascular adverse events associated with doxorrubicin-based chemotherapy drugs. (Arq Bras Cardiol. 2018; 111(5):721-728) Keywords: Breast Neoplasms; Vascular Stiffness; Stroke Volume/drug effects; Cardiotoxicity; Doxorubicin/adverse effects; Cyclophosphamide/adverse effects. Introduction Breast cancer is the most common cancer among women in Brazil and in the world, second only to non-melanoma skin cancer, accounting for approximately 25% of new cases each year. 1 Advances in cancer therapy have resulted both in the improvement of quality of life and in the increase of cancer patients survival. 2 However, in spite of the evolution in the pharmacological treatment of the different neoplasms, several studies have indicated a significant increase in the occurrence of cardiovascular adverse events, mainly myocardial dysfunction in patients undergoing chemotherapy with cardiotoxic drugs, such as the anthracycline group and, to a lesser extent, cyclophosphamide. 3-5 Chemotherapy regimens using doxorubicin and cyclophosphamide are the most commonly used in the treatment of breast cancer in Brazil. 6 The cardiotoxic potential of these drugs is already established, and it is evaluated mainly by Doppler echocardiography in studies showing an increase in the incidence of Heart Failure (HF) in patients who received these drugs. 7 The early identification of the appearance of cardiovascular alterations in patients during chemotherapy with drugs considered cardiotoxic could help adjust cancer treatment, with the adoption of preventive, substitutive measures or their interruption, aiming at minimizing cardiovascular adverse events caused by these agents. 7,8 721