Relationship between regional left ventricular dysfunction and cancer-therapy-related cardiac dysfunction

Heart. 2020 Nov;106(22):1752-1758. doi: 10.1136/heartjnl-2019-316339. Epub 2020 Mar 24.

Abstract

Objective: The aim of our study was to assess the association between risk of cancer-therapy-related cardiac dysfunction (CTRCD) after first follow-up and the difference in echocardiographic measures from baseline to follow-up.

Methods: We retrospectively enrolled 87 consecutive patients (58±14 years, 55 women) who received anthracycline and underwent echocardiographic examinations both before (baseline) and after initial anthracycline administration (first follow-up). We measured absolute values of global longitudinal strain (GLS), apical longitudinal strain (LS), mid-LS and basal-LS at baseline and first follow-up, and per cent changes (Δ) of these parameters were calculated. Among 61 patients who underwent further echocardiographic examinations (second follow-up, third follow-up, etc), we assessed the association between regional left ventricular (LV) systolic dysfunction from baseline to follow-up and development of CTRCD, defined as LV ejection fraction (LVEF) under 53% and more absolute decrease of 10% from baseline, after first follow-up.

Results: LVEF (65%±4% vs 63±4%, p=0.004), GLS (23.2%±2.6% vs 22.2±2.4%, p=0.005) and basal-LS (21.9%±2.5% vs 19.9±2.4%, p<0.001) at first follow-up significantly decreased compared with baseline. Among the 61 patients who had further follow-up echocardiographic examinations, 13% developed CTRCD. In the Cox-hazard model, worse Δbasal-LS was significantly associated with CTRCD. By Kaplan-Meier analysis, patients with Δbasal-LS decrease of more than the median value (-9.7%) had significantly worse event-free survival than those with a smaller decrease (p=0.015).

Conclusions: Basal-LS significantly decreased prior to development of CTRCD, and worse basal-LS was associated with development of CTRCD in patients receiving anthracycline chemotherapy.

Keywords: echocardiography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibiotics, Antineoplastic / adverse effects*
  • Antibiotics, Antineoplastic / therapeutic use
  • Cardiotoxicity
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Diseases / chemically induced
  • Heart Diseases / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Retrospective Studies
  • Risk Factors
  • Stroke Volume / drug effects
  • Stroke Volume / physiology*
  • Ventricular Dysfunction, Left / chemically induced*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / drug effects*

Substances

  • Antibiotics, Antineoplastic