Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer

Br J Cancer. 2009 Jun 16;100(12):1861-6. doi: 10.1038/sj.bjc.6605095. Epub 2009 May 19.


Long-term cardiovascular morbidity is increasingly observed in chemotherapy-treated testicular cancer survivors, but little is known of early sub-clinical changes in cardiac function. We prospectively evaluated cardiac function in testicular cancer patients by echocardiography. Systolic (Wall Motion Score Index) and diastolic (E/A-ratio and Tissue Velocity Imaging (TVI)) parameters, and serum levels of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) were assessed before the start of chemotherapy and 1 year later. Echocardiography data were compared with an age-matched group of healthy controls. Forty-two patients treated with bleomycin, etoposide and cisplatin were evaluated (median age 27 years, range 18-50). Systolic function and E/A-ratio did not change, whereas the median TVI decreased (12.0 vs 10.0 cms(-1); P=0.002). Median levels of NT-proBNP increased (5 vs 18 pmoll(-1), P=0.034). Compared with controls, TVI before the start of chemotherapy was not significantly different. In conclusion, we found that at a median of 10 months after cisplatin-based treatment for testicular cancer, TVI decreased significantly, indicating a deterioration of diastolic cardiac function. Serum levels of NT-proBNP increased. The prognostic significance of these changes for future cardiovascular morbidity is not clear.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Bleomycin / administration & dosage
  • Cisplatin / administration & dosage
  • Cohort Studies
  • Echocardiography
  • Etoposide / administration & dosage
  • Heart / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Orchiectomy
  • Peptide Fragments / blood
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Testicular Neoplasms / blood
  • Testicular Neoplasms / drug therapy*
  • Testicular Neoplasms / physiopathology
  • Ventricular Dysfunction, Left / blood
  • Ventricular Dysfunction, Left / chemically induced*
  • Ventricular Dysfunction, Left / physiopathology
  • Young Adult


  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Bleomycin
  • Natriuretic Peptide, Brain
  • Etoposide
  • Cisplatin