Effetti cardiotossivi precoci e tardivi del trattamento con Epirubicina. Valutazione con marker biochimici ed ecocardiografia Tissue Doppler.

Our study was carried out in a group of epirubicin(Epi)-treated patients with cancer at different sites with the aim of detecting early preclinical changes, that are predictive of the risk of heart failure. All subjects underwent conventional echocardiography, as well as tissue Doppler imaging (TDI) with Strain (ε) and Strain Rate (SR). Moreover, echocardiographic changes identified during the Epi treatment were compared with inflammatory and oxidative stress laboratory markers. Thirty-one patients (age 59±14 yrs) with histologically confirmed tumors at different sites, scheduled to be treated with an Epi-based chemotherapy regimen were enrolled. We prospectively evaluated the acute (one week after) and late effects (3, 6, 12 and 18 months of follow-up) of Epi administration. A significant impairment of the systolic LV function was observed at epirubicin dose 200 mg/m2: this was shown by a reduction of the SR peak in comparison to baseline. This reduction persisted statistically significant throughout the treatment and follow-up, up to 18 months when the Sm reduction became significant. Levels of IL-6, sIL-6R and ROS increased significantly at 200 mg/m2 and IL-6 persisted high at 300 and 400 mg/m2 Epi dose returning within baseline values during follow-up. A significant inverse correlation between ΔSR and both the increase of IL-6 and ROS was observed. The multiple regression analysis showed that both IL-6 and ROS variables were independent and strongly predictive of ΔSR