• Irena Gigovska Dimova Department of Urgent Medicine and Intensive Care, City General Hospital 8th September, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia


Anthracyclines (AT) are the cornerstone of adjuvant chemotherapy in breast cancer (BC) patients. Certain demographic parameters and risk factors predispose to anthracycline-induced cardiotoxicity (ATIC). Close echocardiography monitoring is crucial in diagnosing early cardiac changes, thus preventing further adverse cardiac events and withholding the cancer therapy. This study aims to assess possible changes in left ventricular (LV) dimensions, wall thicknesses and LV mass according to certain demographic characteristics and cardiovascular (CV) risk factors, as well as their relations in patients with BC receiving ATs. We present 30 patients with BC receiving ATs. Demographic parameters and risk factors are: age, body mass index, obesity, hypertension, diabetes, physical activity, risk for AT cardiotoxicity and total AT dose. The echocardiographic parameters followed are LV end-diastolic (LVDd) and end-systolic dimension (LVDs), wall thickness; interventricular septum (IVSd) and posterior wall (PW), as well as LV mass (LVM) and relative wall thickness. Statistical analysis included SPSS v.25.0 LV end-diastolic dimension (LVEDd) significantly increased at the control evaluation (p=0,026). Correlation between the differences in LVEDd and LVEDs between the two visits showed significant relation of the increase with higher indexed AT dose (p=0,007, p=0,030). Higher indexed AT dose was independent predictor for increased both LVEDd and LVEDs at the control evaluation. AT provoke significant echocardiography changes in BC patients and frequent surveillance provides assessment of early changes as an introduction to CTRCD. Further investigation is needed for a more sensitive ATIC discussion.

Keywords: anthracyclines, breast cancer, echocardiography, left ventricular dimensions, left ventricular mass.


1. Breast Cancer Statistics | How Common Is Breast Cancer? | American Cancer Society. (n.d.).
2. Willis, M. S., Parry, T. L., Brown, D. I., Mota, R. I., et al. (2019). Doxorubicin exposure causes subacute cardiac atrophy dependent on the striated muscle–specific ubiquitin ligase MURF1. Circ Heart Fail, 12(3).
3. American Cancer Society. Breast Cancer Facts & Figures 2022-2024. Atlanta: American Cancer Society, Inc.2022
4. Lancellotti, P., Suter, T. M., López-Fernández, T., Galderisi, M., Lyon, A. R., Van der Meer, P., et al. (2018). Cardio-Oncology Services: Rationale, organization, and implementation. Eur Heart J, 40(22), 1756–1763.
5. Cancer of the breast (female) - cancer stat facts. SEER. (n.d.). Retrieved 01.31.2023 from
6. Lyon, A.R., López-Fernández, T., Couch, L. S., et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with European Hematology Association, European Society for Therapeutic Radiology and Oncology and International Cardio-Oncology Society. Eur. Heart J., 43 (41), 4229–4361
7. Cardinale, D., Iacopo, F., & Cipolla. C. M. et al. (2020) Cardiotoxicity of Anthracyclines. Front Cardiovasc Med, 7.
8. Čelutkienė, J., Pudil, R., López‐Fernández, T., et al. (2020) Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: A position statement on behalf of the Heart Failure association, European association of Cardiovasc. Imaging and cardio‐oncology Council of ESC Eur.J.Heart Fail.,22(9),1504–1524
9. Lyon, A. R., Dent, S., Stanway, S., et al. (2020). Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: A position statement and new risk assessment tools from the Cardio‐Oncology study Group of the Heart Failure Association of the ESC in collaboration with the International Cardio‐ Oncology society. Eur. J. Heart Fail., 22(11), 1945–1960.
10. Zamorano, J. L., Lancellotti, P., Rodriguez Muñoz, D. et al. 2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur. Heart J., 37(36), 2768–2801.
11. Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., et al. (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 28(1).
12. Early Breast Cancer Trialists’ Collaborative Group (2012) Comparisons between different polychemotherapy regimens for early breast cancer: Meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. The Lancet, 379(9814), 432–444.
13. Braybrooke, J., Bradley, R., Gray, R., et al. (2023). Anthracycline-containing and Taxane-containing chemotherapy for early-stage operable breast cancer: A patient-level meta-analysis of 100 000 women from 86 randomised trials. The Lancet, 401(10384), 1277–1292.
14. Guarneri, V., & de Azambuja, E. (2022). Anthracyclines in the treatment of patients with early breast cancer. ESMO Open, 7(3), 100461.
15. Larsen. C. M., Garcia Arango, M., Dasari, H et al. (2023) Association of anthracycline with heart failure in patients treated for breast cancer or lymphoma,1985-2010.JAMA, 6 (2)
16. O’Connell, J. L., Romano, M. M., Campos Pulici, E. C., et al. (2017). Short-term and long-term models of doxorubicin-induced cardiomyopathy in rats: A comparison of functional and histopathological changes. Exp Toxicol Pathol, 69(4), 213–219. 2017.01.004
17. Iarussi, D, Galderisi, M, Ratti, G. et al (2001) Left ventricular systolic and diastolic function after anthracycline chemotherapy in childhood. Clin Cardiol, 24(10), 663–669.
18. Neilan, T. G., Coelho-Filho, O. R., Pena-Herrera, D., Shah, R. V., et al. (2012). Left ventricular mass in patients with a cardiomyopathy after treatment with anthracyclines. Am J Cardiol, 110(11), 1679–1686.
19. Jordan, J. H., Castellino, S. M., Meléndez, G. C., et al. (2018). Left ventricular mass change after anthracycline chemotherapy. Circ Heart Fail, 11(7).
20. Ferreira de Souza, T., Quinaglia. A. C. Silva, T., et al. (2018) Anthracycline therapy is associated with cardiomyocyte atrophy and preclinical manifestations of heart disease. JACC Cardiovasc Imaging.11(8), 1045–1055
21. Volkova, M., & Russell, R. (2012) Anthracycline cardiotoxicity: Prevalence, pathogenesis and treatment. Curr Cardiol Rev, 7(4), 214–220.
22. Berthiaume, J. M., Oliveira, P. J., Fariss, M. W., & Wallace, K. B. (2005). Dietary vitamin E decreases doxorubicin- induced oxidative stress without preventing mitochondrial dysfunction. Cardiovasc Toxicol, 5(3), 257–268.
23. Mehta, L. S., Watson, K. E., Barac, A., Beckie, T. M., et al. (2018). Cardiovascular disease and breast cancer: Where these entities intersect: A scientific statement from the American Heart Association. Circulation, 137(8).
24. Guenancia, C., Lefebvre, A., Cardinale, D., et al. (2016). Obesity as a risk factor for anthracyclines and trastuzumab cardiotoxicity in breast cancer: A systematic review and meta-analysis. JCO, 34(26), 3157–3165.
25. de Azambuja, E., McCaskill-Stevens, W., Francis, P. et al. (2009) The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: The experience of 02-98 trial. Breast Cancer Res Treat, 119(1),145–153.
26. Mitra, M., Donthamsetty, S., White, B., & Mehendale, H. (2008). High fat diet-fed obese rats are highly sensitive to doxorubicin-induced cardiotoxicity. Toxicol Appl Pharmacol, 231(3), 413–422.
27. Kala, P., Bartušková, H., Piťha, J., et al. (2020). Deleterious effects of hyperactivity of the renin-angiotensin system and hypertension on the course of chemotherapy-induced heart failure after doxorubicin administration: A study in ren-2 transgenic rat. Int J Mol Sci, 21(24), 9337.
28. Philip, L. J., Findlay, S. G., & Gill, J. H. (2022). Baseline blood pressure and development of cardiotoxicity in patients treated with anthracyclines: A systematic review. Int J Cardiol Cardiovasc Risk Prev, 15, 200153.
29. Reinbolt, R. E., Patel, R., Pan, X., et al. (2015). Risk factors for anthracycline-associated cardiotoxicity. Support Care Cancer, 24(5), 2173–2180.
30. Jin, H., Xu, J., Sui, Z., & Wang, L. (2023). Risk factors from Framingham risk score for anthracyclines cardiotoxicity in breast cancer: A systematic review and meta-analysis. Front Cardiovasc Med, 10.
31. Kang, D.-W., Wilson, R. L., Christopher, C. N., et al. (2022) Exercise as a potential therapeutic modality in the management of anthracycline-induced cardiotoxicity. Front Cardiovasc Med, 8.
32. Antunes, P., Joaquim, A., Sampaio, F., et al. (2023). Effects of exercise training on cardiac toxicity markers in women with breast cancer undergoing chemotherapy with anthracyclines: A randomized controlled trial. Eur J Prev Cardiol, 30(9), 844–855.
How to Cite
GIGOVSKA DIMOVA, Irena. ECHOCARDIOGRAPHIC CHANGES IN LEFT-VENTRICULAR DIMENSIONS AND LEFT-VENTRICULAR MASS IN BREAST CANCER PATIENTS SCHEDULED TO RECEIVE ANTHRACYCLINES. Journal of Morphological Sciences, [S.l.], v. 7, n. 1, p. 84-95, apr. 2024. ISSN 2545-4706. Available at: <>. Date accessed: 20 june 2024.