you may not want to read this one if you got anthracyclines

[Lani]

looking closer, for more subtle changes , they found a higher incidence of heart changes.This may not be so dire (it is just not known): Since they were looking for subclinical (those without symptoms / signs) changes, it is unclear whether these would ever become symptomatic and how they would progress( or improve) with time, but since they are talking of actual remodelling of the heart muscle in the left ventricle it sounds pretty irreversible

I post this not to scare but to help those wondering whether to go with AC then T or TCH and without information on their TOPO II level (still "not actually proven in a large clinical trial" as the lingo goes, make up their minds based on available evidence of the risks, benefits:

Minerva Cardioangiol. 2007 Dec;55(6):711-20.
Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy.

Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F, Biondi-Zoccai G.
Division of Heart Failure and Cardiac Rehabilitation, Cardiovascular Department, Catholic University of the Sacred Heart Rome, Italy gbiondizoccai@gmail.com.
AIM: Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling. METHODS: Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months). RESULTS: At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA) >1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P<0.05). CONCLUSION: Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.
PMID: 18091640 [PubMed - in process]