All patients reached the scheduled cumulative epirubicin dose of 400 mg/m2. Chemotherapy associated with salidroside was well tolerated in all patients. Fifteen patients were randomly selected to undertake the intra- and learn more interobserver reproducibility of the SR. Conventional Echocardiography,

SRI, and Laboratory Data No significant abnormalities of the LVEF were found in either of the two groups throughout the entire treatment period (table II). However, we observed a reduction in the SR peak at t2 (p < 0.05) at an epirubicin dose of 200 mg/m2, with no significant differences between the salidroside and placebo groups (1.35 ± 0.36 vs 1.42 ± 0.49/second, p > 0.05). With growing cumulative doses of epirubicin, the SR normalized only in the salidroside group, showing a significant

difference in comparison with the placebo group at epirubicin doses of 300 mg/m2 (1.67 ± 0.43 vs 1.32 ± 0.53/second, p < 0.05) and PLX-4720 cost 400 mg/m2 (1.68 ± 0.29 vs 1.40 ± 0.23/second, p < 0.05) [table II]. Furthermore, Epigenetics inhibitor the ROS serum concentrations significantly increased at t2 in the placebo group (498 ± 41 vs 849 ± 15 FORT-U, p < 0.05), whereas they remained unchanged in the salidroside group (498 ± 30 vs 519 ± 12 FORT-U, p > 0.05) [table III]. We randomly selected 15 patients to undertake the intra- and interobserver reproducibility of the myocardial strain, and both intra- and interobserver variability were below 13% (table IV). Table II Conventional echocardiographic and strain rate imaging parameters in DOK2 the two groupsa Table III Serum concentrations of reactive oxygen species in the two groupsa Table IV Intra- and interobserver variabilitya of the strain rate in 15 randomly selected patients Correlations between Echocardiographic and Laboratory Data We also correlated early impairment of significant echocardiographic parameters (calculated as a change in the SR [ΔSR] by subtracting the values from the baseline values) with an increase

in serum concentrations of ROS after 200 mg/m2 of epirubicin. We found modest correlations between the ΔSR and an increase in plasma concentrations of ROS (r =0.49, p < 0.05). Discussion Although epirubicin is one of the most powerful antineoplastic agents, its clinical use is limited by dose-related cardiotoxicity.[7] Epirubicin-induced myocardial dysfunction detected early by serial tissue Doppler echocardiography has been correlated with oxidative stress markers with an unchanged LVEF during epirubicin chemotherapy.[8] DTI associated with SRI has shown its value in early detection of epirubicin-induced cardiotoxicity, and a measurable SR peak depression has been regarded as the earliest sign of left ventricular regional systolic dysfunction in epirubicin-treated patients long before a clinical manifestation of heart failure.