Relation of Pre-anthracycline Serum Bilirubin Levels to Left Ventricular Ejection Fraction after Chemotherapy

Research output: Contribution to journalArticle

Authors

External Institution(s)

  • Wake Forest University

Details

Original languageEnglish (US)
Pages (from-to)1752-1755
Number of pages4
JournalAmerican Journal of Cardiology
Volume116
Issue number11
StatusPublished - Dec 1 2015
Peer-reviewedYes

Abstract

Myocardial injury because of oxidative stress manifesting through reductions in left ventricular ejection fraction (LVEF) may occur after the administration of anthracycline-based chemotherapy (A-bC). We hypothesized that bilirubin, an effective endogenous antioxidant, may attenuate the reduction in LVEF that sometimes occurs after receipt of A-bC. We identified 751 consecutively treated patients with cancer who underwent a pre-A-bC LVEF measurement, exhibited a serum total bilirubin level <2 mg/dl, and then received a post-A-bC LVEF assessment because of symptomatology associated with heart failure. Analysis of variance, Tukey's Studentized range test, and chi-square tests were used to evaluate an association between bilirubin and LVEF changes. The LVEF decreased by 10.7 ± 13.7%, 8.9 ± 11.8%, and 7.7 ± 11.5% in group 1 (bilirubin at baseline ≤0.5 mg/dl), group 2 (bilirubin 0.6 to 0.8 mg/dl), and group 3 (bilirubin 0.9 to 1.9 mg/dl), respectively. More group 1 patients experienced >15% decrease in LVEF compared with those in group 3 (p = 0.039). After adjusting for age, coronary artery disease/myocardial infarction, diabetes mellitus, hematocrit, and the use of cardioactive medications, higher precancer treatment bilirubin levels and lesser total anthracycline doses were associated with LVEF preservation (p = 0.047 and 0.011, respectively). In patients treated with anthracyclines who subsequently develop symptoms associated with heart failure, pre-anthracycline treatment serum bilirubin levels inversely correlate with subsequent deterioration in post-cancer treatment LVEF. In conclusion, these results suggest that increased levels of circulating serum total bilirubin, an intrinsic antioxidant, may facilitate preservation of LVEF in patients receiving A-bC for cancer.

Citation formats

APA

Vera, T., D'Agostino, R. B., Jordan, J. H., Whitlock, M. C., Meléndez, G. C., Lamar, Z. S., ... Hundley, W. G. (2015). Relation of Pre-anthracycline Serum Bilirubin Levels to Left Ventricular Ejection Fraction after Chemotherapy. American Journal of Cardiology, 116(11), 1752-1755. https://doi.org/10.1016/j.amjcard.2015.08.042

Harvard

Vera, T, D'Agostino, RB, Jordan, JH, Whitlock, MC, Meléndez, GC, Lamar, ZS, Porosnicu, M, Bonkovsky, HL, Poole, LB & Hundley, WG 2015, 'Relation of Pre-anthracycline Serum Bilirubin Levels to Left Ventricular Ejection Fraction after Chemotherapy', American Journal of Cardiology, vol. 116, no. 11, pp. 1752-1755. https://doi.org/10.1016/j.amjcard.2015.08.042