421 The Utility of Echocardiographic Myocardial Work in the Prediction of Cancer Therapy-Related Cardiac Dysfunction

Abstract

Myocardial work (MW) is a novel technique which utilises speckle tracking strain derived global longitudinal strain (STGLS) in conjunction with the blood pressure to account for afterload. However there is limited data on the clinical utility of MW in the prediction of cancer therapy-related cardiac dysfunction (CTRCD). Therefore our aim was to determine if MW was superior to STGLS in the prediction of CTRCD. Women requiring anthracycline (A) and/or trastuzumab (T) containing chemotherapy regimens for breast cancer underwent serial cardiovascular magnetic resonance imaging (CMR) and echocardiography at baseline, 1, 4 and 12 months following chemotherapy. STGLS and MW parameters were measured, including global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE). 22 women were included in this study with 16 (73%) having adequate imaging for measurement of STGLS and MW parameters. At 4 months 6 (38%) patients had a drop of ≥10% in LVEF on CMR, although this change was not statistically significant (74.0±6.9% vs 60.8±6.0%, p=0.26) and only 1 patient had LVEF<55%. At 1 month, prior to any change in LVEF, the change in STGLS from baseline was not predictive of the future drop in LVEF at 4 months (p=0.06). Of the MW parameters only GWE was predictive of ≥10% drop in LVEF (4.17±3.7 vs -1.9±6.0%, p=0.04). As MW parameters account for changes in afterload they may be a more sensitive marker of subclinical CTRCD, however larger scale trials will better determine the utility in this patient population.