Baseline global longitudinal strain predictive of anthracycline-induced cardiotoxicity

Raquel Araujo-Gutierrez,Yuanchen Wang,Barry H Trachtenberg,Alpana Senapati,Elizabeth Kinder,Jiaqiong Xu,Mahwash Kassi,Kalyan R Chitturi,L Bindu Chebrolu

doi:10.1186/s40959-021-00090-2

Raquel Araujo-Gutierrez, Yuanchen Wang + Show 7 more

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https://doi.org/10.1186/s40959-021-00090-2

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Abstract

BackgroundCancer therapy-related cardiac dysfunction (CTRD) is a major source of morbidity and mortality in long-term cancer survivors. Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited.ObjectivesThe purpose of this study was to investigate whether baseline echocardiographic assessment of global longitudinal strain (GLS) before treatment with anthracyclines is predictive of (CTRD) in a broad cohort of patients with normal baseline LVEF.MethodsStudy participants comprised 188 patients at a single institution who underwent baseline 2-dimensional (2D) speckle-tracking echocardiography before treatment with anthracyclines and at least one follow-up echocardiogram 3 months after chemotherapy initiation. Patients with a baseline LVEF <55% were excluded from the analysis. The primary endpoint, (CTRD), was defined as an absolute decline in LVEF > 10% from baseline and an overall reduced LVEF <50%. Potential and known risk factors were evaluated using univariable and multivariable Cox proportional hazards regression analysis.ResultsTwenty-three patients (12.23%) developed (CTRD). Among patients with (CTRD), the mean GLS was -17.51% ± 2.77%. The optimal cutoff point for (CTRD) was -18.05%. The sensitivity was 0.70 and specificity was 0.70. The area under ROC curve was 0.70. After adjustment for cardiovascular and cancer therapy related risk factors, GLS or decreased baseline GLS ≥-18% was predictive of (CTRD) (adjusted hazards ratio 1.17, 95% confidence interval 1.00, 1.36; p = 0.044 for GLS, or hazards ratio 3.54; 95% confidence interval 1.34, 9.35; p = 0.011 for decreased GLS), along with history of tobacco use, pre-chemotherapy systolic blood pressure, and cumulative anthracycline dose.ConclusionsBaseline GLS or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline LVEF. This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD).

Highlights

Used in the treatment of hematologic malignancies and solid tumors, anthracyclines can lead to cancer therapy-related cardiac dysfunction (CTRD) in approximately 9% of patients and is mostly diagnosed within the first year of treatment in patients who are monitored prospectively
Baseline global longitudinal strain (GLS) or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline left ventricular ejection fraction (LVEF). This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD)
Recent retrospective studies of patients with hematological malignancies show that baseline GLS before initiation of anthracycline therapy is predictive of left ventricular systolic dysfunction or major adverse cardiac events, including cardiac death or symptomatic heart failure [7,8,9]

Summary

Introduction

Used in the treatment of hematologic malignancies and solid tumors, anthracyclines can lead to cancer therapy-related cardiac dysfunction (CTRD) in approximately 9% of patients and is mostly diagnosed within the first year of treatment in patients who are monitored prospectively. Recent retrospective studies of patients with hematological malignancies show that baseline GLS before initiation of anthracycline therapy is predictive of left ventricular systolic dysfunction or major adverse cardiac events, including cardiac death or symptomatic heart failure [7,8,9]. These studies included patients with borderline LVEF (50–55%). Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited

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