Subclinical Cardiotoxicity Post Anthracycline in an African Population

Document Type



Internal Medicine (East Africa); Brain and Mind Institute


Introduction: Anthracyclines, though known to improve survival in some malignancies, is known to be associated with cardiotoxicity. Early detection of cardiotoxicity provides an opportunity for treatment adjustment. Several parameters precede development of clinically manifest cardiac dysfunction. The study aimed to evaluate clinical and echocardiographic parameters associated with the development of cardiac dysfunction in a sub-Saharan African population.

Methods: Cases and controls were respectively defined as cancer patients receiving anthracyclines at a tertiary centre where LV dysfunction on follow up echocardiogram did, or did not occur. Eligible patients were ≥18 years at first anthracycline dose, had an archived baseline echocardiogram, had no history of heart disease nor prior anthracycline use. Patients underwent baseline clinical, drug therapy and radio-therapy assessments. Baseline and follow-up left ventricular systolic and diastolic function were assessed. Subclinical LV dysfunction was defined according to the 2016 ESC position paper on cardiotoxicity (decline in LVEF and GLS).

Results: Of 504 patients who received anthracyclines, 141 fullfilled inclusion criteria, with age 48 years, Africans 95%, females 85%, breast cancer 82%. 39 (27.7%) had cardiac dysfunction, 30 of whom fulfilled the GLS criterion. Mean echo follow up was 14.9 months (cases 16.4; controls 14.4), mean cardiotoxic doxorubicin equivalence dose was 237 mg/m2 for cases and 217 mg/m2 for controls (p = 0.033), mean DASI scores 49 for cases and 51 for controls. Cycle intervals, body surface area, body mass index, blood pressure, age, other therapy and cardiovascular factors were similar. E/a ratio and E’ were reduced in cases (E/a: 1.02 ± 0.33 vs 1.16 ± 0.36, p =0.02 and E: 0.10 ± 0.05 vs 0.11 ± 0.05 p =0.01).

Conclusions: This is the first study evaluating subclinical cardiotoxicity after anthracycline use in an adult Sub-Saharan population. The incidence of subclinical cardiotoxicity in our study population, which received standard dose anthracyclines, was 27.7%, higher than previously studied populations. Routine pre- and post-exposure cardiac assessment should be considered at a low threshold in an African population receiving anthracyclines.