Aims: To describe the use and determine the practical impact of routine baseline left ventricular function testing prior to administration of anthracycline chemotherapy in breast cancer patients.
Methods: We conducted a single-centre retrospective study of breast cancer patients who received, or were planned to receive, treatment with an anthracycline-containing regimen in the neoadjuvant or adjuvant setting from 1 July 2013 to 31 December 2022. Patients were excluded if they also received anti-HER2 therapy. The use of investigations to determine baseline left ventricular ejection fraction (LVEF), the impact of these investigation results on anthracycline prescribing, and their relationship to the development of cardiotoxicity were evaluated.
Results: 99 patients fulfilled eligibility criteria. Median age was 55 years, 100% (n = 99) were female and 86% (n = 85) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. 41% (n = 41) had no traditional cardiovascular risk factors out of smoking, diabetes, hypertension and obesity, whereas 34% (n = 34) had 1 factor and 24% (n = 24) had 2 or more. 87% (n = 86) underwent LVEF assessment before commencing anthracycline chemotherapy, with echocardiogram and nuclear medicine gated blood pool scan utilised in 53% (n = 46) and 47% (n = 40) of cases, respectively. Baseline LVEF ranged from 49% to 76%. No patients were deemed ineligible for anthracycline treatment on the grounds of their pre-chemotherapy LVEF result. Of the 98 patients who went on to receive at least one cycle of anthracycline chemotherapy, 2% (n = 2) developed symptomatic reduction in LVEF to a value below 50% or by a total of 10% or more from baseline.
Conclusions: Over a 9.5-year period, baseline LVEF testing was commonly performed, but failed to detect any cases of pre-existing left ventricular dysfunction that altered physicians’ decisions to prescribe anthracycline chemotherapy.