The clinical utility of baseline cardiac assessments prior to adjuvant anthracycline chemotherapy in breast cancer: a systematic review and meta-analysis

  • Pierre O’BrienEmail author
  • Kara Matheson
  • Alwin Jeyakumar
  • Kim Anderson
  • Tallal Younis



Cardiac assessment with multi-gated acquisition scan (MUGA) or echocardiography (ECHO) is commonly employed prior to adjuvant anthracycline-based chemotherapy (AA). However, the clinical utility of routine baseline cardiac assessments prior to AA for early-stage breast cancer (EBC) is unknown.


To determine: (i) the clinical utility of routine baseline cardiac assessments prior to AA for EBC and (ii) identify patients in whom baseline cardiac assessments may not be warranted.


A systematic review of the literature was conducted to identify all relevant studies that met predefined criteria. The clinical utility was defined by: (i) the rates of abnormal baseline left ventricular ejection fraction (LVEF) and (ii) the rates of change in chemotherapy decisions prompted by baseline LVEF results.


Eight studies met our criteria, of whom six (n = 2545) reported rates of abnormal LVEF and six (n = 1713) reported rates of change in chemotherapy decision. Overall, 2.5% (95% CI 2.0–4.0%) of patients had abnormal baseline LVEF and 1.6% (95% CI 1.0–3.0%) had a change in chemotherapy decision. In subset analyses, the underlying imaging modality (ECHO vs. MUGA) or inclusion of patients with metastatic disease (YES vs. NO) did not significantly affect these rates. There were no consistently identified underlying predictors of abnormal baseline LVEF across studies.


Routine baseline cardiac assessments prior to AA in all EBC patients have low yield and infrequently affect clinical management. Future studies should further examine potential predictors of abnormal cardiac functions in an attempt to identify low risk patients in whom routine baseline LVEF assessment may not be warranted and prevent delay in chemotherapy administration.


Breast cancer Anthracyclines Cardiotoxicity Routine Screening 



Multi-gated acquisition scan




Adjuvant anthracycline chemotherapy


Early-stage breast cancer


Left ventricular ejection fraction


Metastatic breast cancer



This study did not receive any funding.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Human and Animal Rights Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10549_2018_5114_MOESM1_ESM.pdf (122 kb)
Supplementary material 1 (PDF 121 KB)


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Division of Medical OncologyDalhousie UniversityHalifaxCanada
  3. 3.Division of CardiologyDalhousie UniversityHalifaxCanada
  4. 4.QEII Health Sciences CentreHalifaxCanada

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