ABC | Volume 111, Nº5, November 2018

Original Article Souza et al Arterial Stiffness and Cardiotoxicity Arq Bras Cardiol. 2018; 111(5):721-728 This study used the oscillometric method in the upper limb to show an increase in PWV and other hemodynamic parameters in 53 children with malignant tumors treated with anthracyclics. 29 However, there was no difference in PWV after treatment with anthracyclines for a period of at least 1 year and without evaluation in the early stages of treatment. No other study in the literature that was researched evaluated any immediate changes in hemodynamic parameters shortly after the chemotherapy infusion of the AC regimen. Although we performed this assessment, we did not observe significant changes at this stage of treatment. Our study showed an agreement between the parameters related to the estimation of AS by the oscillometric method and those observed in the LVEF values obtained from transthoracic Doppler echocardiography, in an early period of administration of chemotherapeutic agents. These data suggest that later studies, with longer follow‑up and a larger sample, should test AS estimation through the method described as a practical and accessible tool for cardiovascular monitoring of breast cancer patients undergoing chemotherapy and using drugs with known cardiovascular toxicity potential. Conclusion The application of measures of hemodynamic parameters that correlate with arterial stiffness, evaluated by oscillometric method of the upper limb, as well as the values of left ventricular ejection fraction, measured by transthoracic Doppler echocardiogram, was not changed in the early phase of chemotherapy - up to the fourth cycle of chemotherapy - in women with breast cancer on doxorubicin and cyclophosphamide. Author contributions Conception and design of the research: Souza CA, Simões R, Malachias MVB, Drummond-Lage AP, Rezende BA; Acquisition of data: Souza CA, Simões R, Oliveira AN, Zogeib JB, Alves B; Analysis and interpretation of the data and Critical revision of the manuscript for intellectual content: Souza CA, Simões R, Borges KBG, Oliveira AN, Zogeib JB, Alves B, Malachias MVB, Drummond-Lage AP, Rezende BA; Statistical analysis and Obtaining financing: Rezende BA; Writing of the manuscript: Souza CA, Simões R, Borges KBG, Oliveira AN, Malachias MVB, Drummond-Lage AP, Rezende BA. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by FAPEMIG. Study Association This article is part of the thesis of master submitted by Cláudio Antônio de Souza, from Faculdade de Ciências Médicas de Minas Gerais. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Universidade Federal de Minas Gerais (CAAE 38538714.2.0000.5149) under the protocol number 1408811. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 1. Fayer VA, Guerra MR, Cintra JR, Bustamante-Teixeira MT. Ten-year survival and prognostic factors for breast cancer in the southeast region of Brazil. Rev Bras Epidemiol. 2016;19(4):766-78. 2. Wu AH. Cardiotoxic drugs: clinical monitoring and decisionmaking. Heart. 2008;94(11):1503-9. 3. Chaosuwannakit N, D’Agostino R, Hamilton CA, Lane KS, Ntim WO, Lawrence J, et al. Aortic stiffness increases upon receipt of anthracycline chemotherapy. J Clin Oncol. 2010;28(1):166-72. 4. Koelwyn GJ, Lewis NC, Ellard SL, Jones LW, Gelinas JC, Rolf JD, et al. Ventricular-arterial coupling in breast cancer patients after treatment with anthracycline-containing adjuvant chemotherapy. Oncologist. 2016;21(2):141-9. 5. Mozos I, Borzak G, Caraba A, Mihaescu R. Arterial stiffness in hematologic malignancies. Onco Targets Ther. 2017 Mar 3;10:1381-8. 6. Brasil. Ministerio da Saúde. Diretrizes diagnosticas e terapeuticas do carcinoma de mama. Brasília; 2018. p.38. 7. Kalil Filho R, Hajjar LA, Bacal F, Hoff PM, Diz MeP, Galas FR, et al; Grupo de Estudos em Insuficiência Cardíaca da Sociedade Brasileira de Cardiologia (GEIC/SBC); Sociedade Brasileira deOncologia Clínica; Instituto doCoração – Faculdade deMedicina daUniversidade de São Paulo; Instituto doCâncer do Estado de São Paulo – Faculdade de Medicina da Universidade de São Paulo. [I BrazilianGuideline for Cardio-Oncology fromSociedade Brasileira de Cardiologia]. Arq Bras Cardiol. 2011;96(2 Suppl 1):1-52. 8. Chang HM, Okwuosa TM, Scarabelli T, Moudgil R, Yeh ET. Cardiovascular complications of cancer therapy: best practices in diagnosis, prevention, and management: part 2. J Am Coll Cardiol. 2017;70(20):2552-65. 9. Mikael LR, Paiva AM, Gomes MM, Sousa AL, Jardim PC, Vitorino PV, et al. Vascular aging and arterial stiffness. Arq Bras Cardiol. 2017;109(3):253-8. 10. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873-926. 11. Drafts BC, Twomley KM, D’Agostino R, Lawrence J, Avis N, Ellis LR, et al. Low tomoderate dose anthracycline-based chemotherapy is associatedwith early noninvasive imaging evidence of subclinical cardiovascular disease. JACC Cardiovasc Imaging. 2013;6(8):877-85. References 726