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The clinical utility of baseline cardiac assessments prior to adjuvant anthracycline chemotherapy in breast cancer: a systematic review and meta-analysis

  • Pierre O’BrienEmail author
  • Kara Matheson
  • Alwin Jeyakumar
  • Kim Anderson
  • Tallal Younis
Review

Abstract

Background

Cardiac assessment with multi-gated acquisition scan (MUGA) or echocardiography (ECHO) is commonly employed prior to adjuvant anthracycline-based chemotherapy (AA). However, the clinical utility of routine baseline cardiac assessments prior to AA for early-stage breast cancer (EBC) is unknown.

Objectives

To determine: (i) the clinical utility of routine baseline cardiac assessments prior to AA for EBC and (ii) identify patients in whom baseline cardiac assessments may not be warranted.

Methods

A systematic review of the literature was conducted to identify all relevant studies that met predefined criteria. The clinical utility was defined by: (i) the rates of abnormal baseline left ventricular ejection fraction (LVEF) and (ii) the rates of change in chemotherapy decisions prompted by baseline LVEF results.

Results

Eight studies met our criteria, of whom six (n = 2545) reported rates of abnormal LVEF and six (n = 1713) reported rates of change in chemotherapy decision. Overall, 2.5% (95% CI 2.0–4.0%) of patients had abnormal baseline LVEF and 1.6% (95% CI 1.0–3.0%) had a change in chemotherapy decision. In subset analyses, the underlying imaging modality (ECHO vs. MUGA) or inclusion of patients with metastatic disease (YES vs. NO) did not significantly affect these rates. There were no consistently identified underlying predictors of abnormal baseline LVEF across studies.

Conclusions

Routine baseline cardiac assessments prior to AA in all EBC patients have low yield and infrequently affect clinical management. Future studies should further examine potential predictors of abnormal cardiac functions in an attempt to identify low risk patients in whom routine baseline LVEF assessment may not be warranted and prevent delay in chemotherapy administration.

Keywords

Breast cancer Anthracyclines Cardiotoxicity Routine Screening 

Abbreviations

MUGA

Multi-gated acquisition scan

ECHO

Echocardiography

AA

Adjuvant anthracycline chemotherapy

EBC

Early-stage breast cancer

LVEF

Left ventricular ejection fraction

mBC

Metastatic breast cancer

Notes

Funding

This study did not receive any funding.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Human and Animal Rights Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10549_2018_5114_MOESM1_ESM.pdf (122 kb)
Supplementary material 1 (PDF 121 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Division of Medical OncologyDalhousie UniversityHalifaxCanada
  3. 3.Division of CardiologyDalhousie UniversityHalifaxCanada
  4. 4.QEII Health Sciences CentreHalifaxCanada

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