ABC | Volume 112, Nº1, January 2019

Original Article Barros et al Regional wall motion and cardiotoxicity prediction Arq Bras Cardiol. 2019; 112(1):50-56 Figure 1 – Two-dimensional echocardiography–guided M-mode showing abnormal motion of interventricular septum (arrow) during chemotherapy treatment. LV: left ventricle; RV: right ventricle. Table 2 – Characteristics in patients with segmental wall motion abnormality during chemotherapy Patient Age Treatment* Abnormal contraction Echocardiographic follow-up Risk factors CTRCD Follow-up 2 49 1,2, Infero-septal Hypokinesis 5 no yes Death 5 40 1,2 Abnormal Septal motion 2 no yes NYHA I 12 68 1,2 Ínfero-lateral Hypokinesis 5 no yes NYHA I 21 30 1,2 Abnormal Septal motion 3 dyslipidemia no 27 43 1,2 Abnormal Septal motion 2 no no 52 73 1, inferior Hypokinesis 4 Diabetes, Hypertension yes NYHA I 63 53 1 Septal Hypokinesis 2 no no 67 77 1,2 Abnormal Septal motion 4 hypertension yes NYHA II 72 44 1,2 Abnormal Septal motion 2 no no 84 59 1,2 Inferior Hypokinesis 4 no no 88 34 1 Abnormal Septal motion 3 no no 92 39 1 Abnormal Septal motion 3 no yes death 100 41 1 Infero-septal Hypokinesis 2 no no 110 62 1 Septal hypokinesis 2 no yes NYHA ! *1: anthracycline; 2: transtuzumab; CTRCD: cancer therapy-related cardiac dysfunction. of diastolic dysfunction has been reported in up to 57% of patients after treatment with anthracyclines or anthracyclines plus trastuzumab. 28 Cochet et al. 28 Serrano et al. 29 evaluated MUGA-derived diastolic parameters and found that impaired LV diastolic function before treatment was an independent predictor of trastuzumab-mediated cardiotoxicity. Boyd at al. 18 showed in a cohort involving 140 patients followed for seven days that LV diastolic dysfunction grade significantly increased from 46% to 57% (p < 0.001) after treatment with anthracyclines. Importantly, diastolic dysfunction was more prevalent in the subgroup with a significant reduction in GLS, demonstrating the close association between systolic and diastolic dysfunction. 18 A study using MUGA-derived diastolic function parameters investigated whether impairment of systolic function was preceded by diastolic dysfunction in a group of 77 female breast cancer patients undergoing trastuzumab therapy. The results of this study showed a nearly even number of patients with diastolic dysfunction preceding systolic dysfunction (54%), as compared to the number of patients with the opposite order (42%). 30 Discrepancy among those studies is probably related to the different designs and interpretation of the results. 53