Comments on the Letter "Bridging the Gap: The Critical Next Steps for Implementing Genetic Risk Scores in Myocardial Infarction Prevention in Saudi Arabia".

OBJECTIVES

Anthracyclines used in the treatment of breast cancer are known for their cumulative cardiotoxic effect. Two-dimensional speckle tracking echocardiography is a promising technique in detection of subclinical cardiotoxicity. Cardio-oncology rehabilitation is a new field aiming to decrease the risk of cardiovascular diseases and improve cardiopulmonary fitness among cancer patients.

METHODS

The study included 100 female patients with de novo breast cancer and treated with anthracycline-based chemotherapy. Patients were randomly assigned into two groups in a 1:1 ratio. Group (1) included patients who were allocated to cardiac rehabilitation program in addition to their regular chemotherapeutic drugs and group 2 included patients who received chemotherapy only. Standard 2-dimensional echocardiography and 2-dimensional speckle tracking echocardiography for assessment of left ventricle global longitudinal strain were performed to all patients before receiving the chemotherapy and at 3 and 6 months after.

RESULTS

At 3 months, no significant difference was found between Group 1 and Group 2 as regards the left ventricular ejection fraction and left atrial volume Index. However, a significant difference was observed as regards E/E' (5.25 (4.5-5.5) in group 1 versus 7.5 (5-9.5) in group 2 with P value ≤ 0.01) and also in the average global longitudinal strain between the 2 groups; (-18.81 ± 1.39 in group 1 vs. -18.21 ± 1.43 in group 2, P = 0.092). At 6 months, Ejection fraction showed a significant difference between the 2 groups (64.10 ± 3.52 in group 1 vs. 59.46 ± 5.57 in group 2, P ≤ 0.01) which was also accompanied by a significant change in average global longitudinal strain (-18.91 ± 1.39 in group 1 vs. -17.89 ± 1.54 in group 2, P = 0.001). As regards cardiotoxicity (defined as ≥15 % change in average global longitudinal strain), there were no cases detected in group 1 despite the presence of 4 cases (8 %) in group 2 with a mean change of global longitudinal strain (16 %).

CONCLUSION

Cardiac rehabilitation program has a protective role against chemotherapy-induced cardiotoxicity in patients with breast cancer.