The Role of Echocardiography in Chemotherapy

Mailing Address: Angelo Antunes Salgado • Rua Magalhaes Couto, 237, Apt.101, 20735-180, Meier, Rio de Janeiro RJ Brazil. E-mail: angeloasalgado@gmail.com Manuscript received July, 3rd, 2013; accepted October, 14th, 2013 Introduction With the increased survival of the population, and the widespread use of early detection campaigns, there was a substantial increase in the early detection of several types of neoplasias1. The evolution of cancer treatment, both in relation to chemotherapy as radiotherapy, have not diminished the importance of cardiac monitoring of these patients, since the potentially cardiotoxic drugs usually employed as anthracyclines (doxorubicin, epirubicin, idarubicin) and alkylating agents (cyclophosphamide, ifosphamide) are well know and potentially lethal1,2 The importance of early detection of cardiotoxic action of these drugs, when the suspension can still avoid heart damage and even restore normalcy, is already very well established in echocardiography 1.3. Cardiotoxicity caused by chemotherapy days after infusion, even after several years may occur, demonstrating the importance of long-term cardiac follow-up in these patients, which may be acute, subacute or chronic and characterized mainly by electrocardiographic, myocarditis changes, pericarditis and also by cardiac insufficiency.2 Cardiotoxicity depends on the type of infused agent (anthracyclines with agents that cause more dysfunction), usually occurring more at the extremes of age ( 60 years) in female patients with previous cardiac dysfunction and a history of associated mediastinal radiation. The cumulative dose of the chemotherapeutic agent is directly related to the degree of cardiac injury, being more evident dysfunction with cumulative anthracycline dose above 400mg/m2 and infusion bolus2, 4. The incidence of cardiotoxicity caused by anthracycline ranges from 18% to 26% and may reach 36% in patients receiving cumulative doses above 600mg/m2. In some cases heart failure can occur up to 20 years after the administration of the pharmaceutical drug.5 More recent ly i t has been shown that a new immunomodulatory agent trastuzumab used for the treatment of breast cancer in patients with severe expression of the human epidermal growth factor type 2 (HER-2) receptor may also have damage to cardiomyocytes. Despite the myotoxic effect is unknown, it has the ability to reverse cardiac dysfunction after its suspension, which does not occur with anthracyclines and alkylating agents. However, the use of trastuzumab in patients who have previously made use of anthracyclines, increases the incidence of cardiac disorders 2.5.