Electrocardiographic parameters during neoadjuvant chemotherapy

Authors: Buziashvili Yu.I., Asymbekova E.U., Matskeplishvili S.T., Tugeeva E.F., Artamonova E.V., Akildzhonov F.R.

Company: 1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
2 N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation
3 N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
4 M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-2-272-278

For citation: Buziashvili Yu.I., Asymbekova E.U., Matskeplishvili S.T., Tugeeva E.F., Artamonova E.V., Akildzhonov F.R. Electrocardiographic parameters during neoadjuvant chemotherapy. Creative Cardiology. 2023; 17 (2): 272–8 (in Russ.). DOI: 10.24022/1997-3187-2023-17-2-272-278

Received / Accepted:  10.05.2023 / 26.06.2023

Keywords: cardiotoxicity neoadjuvant chemotherapy electrocardiography

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Abstract

Objective. Continuous cardiac monitoring with a 12-lead electrocardiogram (ECG) and transthoracic echocardiography is currently the gold standard in patients receiving chemotherapy. The aim of the study was to analyze ECG parameters in patients during neoadjuvant chemotherapy (NAC).

Material and methods. The prospective study included 72 patients with a confirmed diagnosis of breast cancer (BC) during NAC from March 2021 to February 2022; the mean age was 47.9±11.9 years. ECG registration in 12 leads was performed before the start of NAC, after the 4th course, and also after the completion of the NAC course. We divided the electrocardiogram parameters into the following groups: PQ interval, QRS duration, QT interval, QTc according to the Bazett formula, anomalies identified in the analysis of the ECG.

Results. In patients initially, during and after NAC, the following was revealed: a trend towards an increase in heart rate – 80±14, 86±13 (p=0.08), 92±10 (p=0.00001), respectively. During the analysis of ECG parameters, a significant prolongation of the corrected QTc according to the Bazett formula was observed during the intermediate and final stages of NAC compared with the initial parameters 0.45±0.06 (p=0.003) and 0.48±0.05 (p=0.00001), respectively. Significant prolongation of the QTc interval (> 450 ms) occurred in 54 (75%) patients after NAC.

Conclusion. The study showed that in about one third of all patients with breast cancer against the background of NAC, there is a prolongation of the QTc interval, the development of AV blocks and intraventricular conduction disturbances.

References

  1. Lyon A.R., López-Fernández T., Couch L., Asteggiano R., Aznar M., Bergler-Klein J. et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur. Heart J. 2022; 43 (41): 4229–361. DOI: 10.1093/eurheartj/ehac244
  2. Emdin M., Aimo A., Vergaro G., Bayes-Genis A., Lupón J., Latini R. et al. sST2 predicts outcome in chronic heart failure beyond NT-proBNP and high-sensitivity troponin T. J. Am. Coll. Cardiol. 2018; 72 (19): 2309–20. DOI: 10.1016/j.jacc.2018.08.2165
  3. Akildzhonov F.R., Buziashvili J.I., Stilidi I.S., Asymbekova E.U., Artamonova E.V. Biomarkers in patients after chemotherapy. Medical alphabet. 2021; 19: 49–53 (in Russ.). DOI: 10.33667/2078-5631-2021-19-49-53
  4. Pohl J., Mincu R., Mrotzek S., Wakili R., Mahabadi A., Potthoff S. et al. ECG Scoring for the evaluation of therapy-naïve cancer patients to predict cardiotoxicity. Cancers (Basel). 2021; 13 (6): 1197. DOI: 10.3390/cancers13061197
  5. Pohl J., Mincu R., Mrotzek S., Hinrichs L., Michel L., Livingstone E. et al. ECG Changes in melanoma patients undergoing cancer therapy-data from the ECoR registry. J. Clin. Med. 2020; 9 (7): 2060. DOI: 10.3390/jcm9072060
  6. Parfrey D., O’Connor Byrne N., Murphy P. Electrocardiography before treatment with anthracycline-based chemotherapy in a tertiary hospital in the Republic of Ireland. J. Electrocardiol. 2021; 65: 64–5. DOI: 10.1016/j.jelectrocard.2020.12.013
  7. Kim P., Irizarry-Caro J., Ramesh T., Iliescu C., Lopez-Mattei J. How to diagnose and manage QT prolongation in cancer patients. JACC CardioOncol. 2021; 3 (1): 145–9. DOI: 10.1016/j.jaccao.2021.01.002
  8. Spînu Ș., Cismaru G., Boarescu P., Istratoaie S., Gabriela Negru A., Lazea C. et al. ECG markers of cardiovascular toxicity in adult and pediatric cancer treatment. Dis. Markers. 2021; 2021: 6653971. DOI: 10.1155/2021/6653971
  9. McMullen C., Chalmers S., Wood R., Cunningham M., Currie S. Sunitinib and imatinib display differential cardiotoxicity in adult rat cardiac fibroblasts that involves a role for calcium/calmodulin dependent protein kinase ii. Front. Cardiovasc. Med. 2021; 7: 630480. DOI: 10.3389/fcvm.2020.630480
  10. Kinoshita T., Yuzawa H., Natori K. Early electrocardiographic indices for predicting chronic doxorubicin-induced cardiotoxi-city. J. Cardiol. 2021; 77 (4): 388–94. DOI: 10.1016/j.jjcc.2020.10.007
  11. Pecoraro M., Rodríguez-Sinovas A., Marzocco S., Ciccarelli M., Iaccarino G., Pinto A., Popolo A. Cardiotoxic effects of shortterm doxorubicin administration: involvement of connexin 43 in calcium impairment. Int. J. Mol. Sci. 2017; 18 (10): 2121. DOI: 10.3390/ijms18102121
  12. Bhagat A., Kleinerman E. Anthracycline-induced cardiotoxicity: causes, mechanisms, and prevention. Adv. Exp. Med. Biol. 2020; 1257: 181–92. DOI: 10.1007/978-3-030-43032-0_15
  13. Cheng M., Yang F., Liu J., Yang D., Zhang S., Yu Y. et al. Tyro-sine kinase inhibitors-induced arrhythmias: from molecular mechanisms, pharmacokinetics to therapeutic strategies. Front. Cardiovasc. Med. 2021; 8: 758010. DOI: 10.3389/fcvm.2021.758010
  14. Kim P., Masha L., Olson M., Iliescu C., Karimzad K., Hassan S. et al. QT Prolongation in Cancer Patients. Front. Cardiovasc. Med. 2021; 8: 613625. DOI: 10.3389/fcvm.2021.613625 15. Porta-Sánchez A., Gilbert C., Spears D., Amir E., Chan J., Nanthakumar K. et al. Incidence, diagnosis, and management of QT prolongation induced by cancer therapies: a systematic review. J. Am. Heart Assoc. 2017; 6 (12): e007724. DOI: 10.1161/JAHA.117.007724
  15. Veronese P., Tessariol D., Scanavacca M.I., Hajjar L.A., Wu T.W., Sacilotto L. et al. Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer. PLoS One. 2018; 13 (5): e0196763. DOI: 10.1371/journal.pone.0196763
  16. Liang X., Wang Y., Yin X., Gong X., Pan S., Chen Z., Geng X. Electrocardiographic characteristics of breast cancer patients treated with chemotherapy. Cardiol. Res. Pract. 2020; 2020: 6678503. DOI: 10.1155/2020/6678503
  17. Zamorano J., Lancellotti P., Rodriguez Muñoz D., Aboyans V., Asteggiano R., Galderisi M. et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur. Heart J. 2016; 37 (36): 2768–801. DOI: 10.1093/eurheartj/ehw211
  18. Kuittinen T., Jantunen E., Vanninen E., Mussalo H., Nousiainen T., Hartikainen J. Late potentials and QT dispersion after high-dose chemotherapy in patients with non-Hodgkin lymphoma. Clin. Physiol. Funct. Imaging. 2010; 30 (3): 175–80. DOI: 10.1111/j.1475-097X.2009.00920.x

About Authors

  • Yuriy I. Buziashvili, Dr. Med. Sci., Professor, Academician of RAS, Head of Department; ORCID
  • Elmira U. Asymbekova, Dr. Med. Sci., Leading Researcher; ORCID
  • Simon T. Matskeplishvili, Dr. Med. Sci., Professor, Corresponding Member of RAS, Chief Researcher; ORCID
  • Elvina F. Tugeeva, Dr. Med. Sci., Senior Researcher; ORCID
  • Elena V. Artamonova, Dr. Med. Sci., Head of the Department of Chemotherapy № 1 of the N.N. Blokhin NMRCO, Professor, Department of Oncology and Radiation Therapy, N.I. Pirogov RNRMU, Head of the Department of Oncology and Thoracic Surgery M.F. Vladimirsky MRRCI; ORCID
  • Firdavsdzhon R. Akildzhonov, Postgraduate; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery