369 Patients with chronic heart failure of different classes: Changes of large intestine microflora

Purpose: Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately, means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We thus aimed to e valuate the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling. Methods: Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Results: Fifty-six patients were included (follow-up 9±6 months). At baseline, none had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or NYHA>1. Follow-up analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all p<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10(17.9%) in group 3. All groups shared similar conditions at baseline, patients with adverse LV-TDI remodelling had significant increases in EDD and ESV, as well as a significantly decreased LVEF (all p<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (p<0.05). Conclusions: Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.