Baseline Left Atrial Strain is Predictive of Chemotherapy Induced Cardiotoxicity in High-Risk Cancer Patients

Abstract

Currently, no baseline imaging biomarkers can predict chemotherapy induced cardiotoxicity (CTx). We aimed to determine if baseline left atrial (LA) reservoir strain (LAS) is predictive of CTx. We performed retrospective analysis of the SUCCOUR study, an international multicentre randomised controlled trial. CTx was defined as an asymptomatic drop of >10% in left ventricular ejection fraction (LVEF) compared to baseline to <55%. After excluding 78 with inadequate images, 229 were included in the analysis. Most participants were female (n=215, 94%), with a mean age of 54±12 years. Breast cancer was the main cancer type (n=205, 90%). The mean baseline 3D LVEF, LV global longitudinal strain (GLS), LAS, and LA volume index (LAVI) were 61±4%, 20.6±2.5%, 28.6±7.9%, and 28±9mL/m2, respectively. At 1-year follow-up, 29 patients (13%) developed CTx. On univariable Cox proportional hazard analysis, lower baseline LAS was associated with a higher risk of CTx (HR 0.95, 95% CI 0.90–0.99; p=0.026) but baseline GLS was not (p=0.17). In nested Cox models (Figure 1), adding LAS significantly improved the model’s predictive accuracy for CTx. Baseline LAS is an independent and incremental predictor of CTx. LAS can be used for baseline risk stratification in oncology patients who receive cardiotoxic chemotherapy.