Original Contribution
Table 1: Patients’ Demographic Information Placebo
GENDER (P=0.569) Male
8 Female 14 AGE (YEARS) (P=0.098)
TYPE OF MALIGNANCY (P=0.140) Lymphoma 9 Breast
CHEMOTHERAPY REGIMEN CHOP ABVD CAF
13 6
2 10
MORTALITY (P=0.210) 4
43.50±15.27 45.70±14.16 52.52±11.00 43.50±15.27 5
5
17 3
1
16 2
17 2
2
17 1
6
16 4
2
15 1
ABVD = adriamycin, bleomycin, vinblastine, dacarbazine; CAF = cyclophosphamide, doxorubicin, fluorouracil; CHOP = cytoxan, hydroxyrubicin (Adriamycin), oncovin (Vincristine), prednisone.
The American Heart Hospital Journal
angiotensin receptor blockers, diuretics, or beta-blockers; and patients under 12 years of age.
12.5 mg 25 mg 5 Carvedilol
Carvedilol Carvedilol (both groups) 7
5 15 17 17
anthracyclines leads to a reduction of cardiac complications. Apparently, dexrazoxan hinders the development and activity of ferrous–anthracycline complexes by binding the ferrous particles; this leads to reduced free radical production and, thus, reduced historrhexis.12
Carvedilol obstructs β-1,
β-2, and α-1 receptors and has strong antioxidant and antiapoptotic effects,13
which are highly important for
cardioprotection. Also, carvedilol can suppress sarcoplasmic reticulum Ca2- ATPase. The effects of carvedilol in suppressing apoptosis signaling routes may play a role in cardioprotection.14
The aim of the research presented in this article was to study the protective effect of carvedilol in cardiomyopathy caused by anthracyclines in patients suffering from breast cancer and lymphoma.
Methods
Over the course of one year, patients with a diagnosis of breast malignancies and lymphoma who were under treatment with anthracyclines and who were referred to Shahid Ghazi Clinic entered the study and were followed up for four months. The following patients were excluded from the study: patients with records of chemotherapy, radiotherapy, symptoms of hyperemia, and cardiac insufficiency; patients with approved restrictive and hyperemia cardiomyopathy; patients with coronary vessel disease; those with moderate to severe insufficiency of the mitral and aortic valves in early echocardiography; patients with ramous blocks; patients with thyroid dysfunction; patients in whom carvedilol was contraindicated; patients with serious concurrent disease; patients taking angiotensin-converting enzyme inhibitors,
96
In this clinical trial, 66 patients undergoing chemotherapy were randomly divided into three groups, each containing 22 patients. The first group received placebo and the second and third groups received, respectively, 12.5 mg and 25 mg of apo-carvedilol 24 hours before starting the study. The study lasted for four months. Doxorubicin and epirubicin were prescribed at 50–60 mg and 100 mg per square meter of body area, respectively. The patients in this study underwent echocardiography and tissue Doppler using Vingmed System 7 to look for cardiomyopathy. Left ventricular function was measured during systole and diastole before starting chemotherapy and during the acute phase (in cases where clinical symptoms of cardiomyopathy appeared) and during the chronic phase in the fourth month. Anolous movement of the mitral valve was used to calculate the ejection fraction. A questionnaire was used to collect the required information: age, gender, mortality, type of malignancy, type of chemotherapy regimen and cycle, cumulative dose of doxorubicin and epirubicin, echocardiography results (left ventricular ejection fraction, diastolic end diameter of the left ventricle, systolic end diameter of the left ventricle, E-wave velocity, E/A ratio), results of tissue Doppler (including maximum systolic velocity of the mitral valve, Ei/Ea ratio, inferior–posterior movement of the mitral valve, speed development), and pure systolic and diastolic cardiomyopathy.
The obtained data were analyzed using SPSSTM-15 statistical software. Quantitative variables were compared using the Student t-test (independent samples, paired samples t-test). Categorical variables were compared using contingency tables and the chi-squared test or Fisher’s exact test. In all cases, the results were seen as statistically significant if p≤0.05.
Results
No significant differences were observed among the groups in terms of mortality, age, gender, type of malignancy, chemotherapy regimen, and cumulative dose of doxorubicin and epirubicin (see Table 1). The average cumulative dose of doxorubicin was 540.28±31.17 mg/m2 in the control group, 531.50±29.98 mg/m2 in the group receiving 12.5 mg carvedilol, and 521.14±38.97 mg/m2 in the group receiving 25 mg carvedilol; taking the two groups receiving carvedilol together (case group), the average cumulative dose of doxorubicin was 540.28±31.17 mg/m2. In this regard, no statistically significant difference was observed between the control and case groups (p=0.218). The average cumulative dose of epirubicin was 768.44±26.78 mg/m2 in the control
Protective Effect of Carvedilol in Cardiomyopathy Caused by Anthracyclines Winter 2011
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