Abstract 14293: Echocardiographic Predictors of Symptomatic Cardiotoxicity Among Patients Undergoing Chemotherapy: Systematic Review and Meta-analysis

Abstract

Introduction: Chemotherapeutic agents have been associated with cardiotoxicity and thus require close monitoring. Several echocardiographic variables have been investigated as early predictors of symptomatic cardiotoxicity (SC) in patients undergoing chemotherapy. Hypothesis: We hypothesized that global longitudinal strain (GLS) is a better predictor of SC compared to left ventricular ejection fraction (LVEF) in patients receiving chemotherapy. Methods: MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were searched from through March 2019. Adults who developed SC (symptomatic congestive heart failure, decline in LVEF <50%, cardiac death) after undergoing chemotherapy with pre- and post-chemotherapy echocardiographic measures of cardiac function were included. Primary focus was on the prediction of SC. Estimates were reported as random effects hazard ratios (HR) with 95% confidence intervals (CI). Results: Eight studies met inclusion criteria. Six studies analyzed LVEF and demonstrated a significant association between LVEF and the prediction of SC (HR 1.27; 95% CI, 1.02-1.57; P=0.03) (Figure 1) . Two studies that analyzed GLS found it to be a strong predictor of SC in patients undergoing chemotherapy (HR 1.46; 95% CI, 1.34-1.58; P=<.001) (Figure 2) . Conclusions: Both LVEF and GLS can predict SC, and therefore can be utilized for monitoring patients on chemotherapy for cardiac dysfunction. The data for GLS is more homogenous but definite evidence that GLS may be superior to LVEF is lacking. More randomized blinded trials are required to identify if one echocardiographic parameter may be superior to the other.