Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case-Control Study.

Wojciech Kosmala,Kazuaki Negishi,Sakiko Miyazaki,Ciro Santoro,Monika Przewlocka-Kosmala,Koji Kurosawa,Thomas H Marwick,Dragos Vinereanu,Tomoko Negishi,Masaki Izumo,Mitra Shirazi,Paaladinesh Thavendiranathan,Martin Penicka,Bogdan A Popescu,Goo-Yeong Cho,Klaus Murbræch,Krassimira Hristova,Jonathan De Blois

doi:10.3390/jcm11040912

Abstract

The load dependence of global longitudinal strain (GLS) means that changes in systolic blood pressure (BP) between visits may confound the diagnosis of cancer-treatment-related cardiac dysfunction (CTRCD). We sought to determine whether the estimation of myocardial work, which incorporates SBP, could overcome this limitation. In this case–control study, 44 asymptomatic patients at risk of CTRCD underwent echocardiography at baseline and after oncologic treatment. CTRCD was defined on the basis of the change in the ejection fraction. Those with CTRCD were divided into subsets with and without a follow-up SBP increment >20 mmHg (CTRCD+BP+ and CTRCD+BP−), and matched with patients without CTRCD (CTRCD−BP+ and CTRCD−BP−). The work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were assessed in addition to the GLS. The largest increases in the GWI and GCW at follow-up were found in CTRCD−BP+ patients. The CTRCD+BP− patients demonstrated significantly larger decreases in GWI and GCW than their CTRCD+BP+ and CTRCD−BP− peers. ROC analysis for the discrimination of LV functional changes in response to increased afterload in the absence of cardiotoxicity revealed higher AUCs for GCW (AUC = 0.97) and GWI (AUC = 0.93) than GLS (AUC = 0.73), GWW (AUC = 0.51), or GWE (AUC = 0.63, all p-values < 0.001). GCW (OR: 1.021; 95% CI: 1.001–1.042; p < 0.04) was the only feature independently associated with CTRCD−BP+. Myocardial work is superior to GLS in the serial assessments in patients receiving cardiotoxic chemotherapy. The impairment of GLS in the presence of an increase in GWI and GCW indicates the impact of elevated afterload on LV performance in the absence of actual myocardial impairment.

Highlights

cancer-treatment-related cardiac dysfunction (CTRCD) was detected in seven patients at 3-month follow-up, in eight at 6 months, in five at 9 months, and in two at 12 months
This study shows that the measurement of the myocardial work (MW) might be helpful in the assessment of study cardiotoxicity, when there is aMW
global myocardial work index (GWI), even with decreased indicates the impact of elevated afterload on point of view, the evaluation

Summary

Introduction

Cancer-related mortality has declined substantially over recent decades [1]. The early detection and management of cancer-treatment-related cardiac dysfunction (CTRCD) should be prioritized in patients receiving potentially cardiotoxic chemotherapy. Observational studies indicating global longitudinal deformation (GLS) to be superior to EF in the recognition of subclinical myocardial impairment and prediction of outcome after exposure to cancer therapy [7–12] have recently been confirmed by the 12-month results of the SUCCOUR trial [13]. All the ejection-phase parameters are afterload-dependent and vulnerable to fluctuations in blood pressure, which poses a particular problem with serial assessments. The estimation of myocardial work (MW), to allow the correction of GLS for changes in systolic blood pressure [14–17], may improve diagnostic accuracy in this setting. In this study, we sought to investigate the utility of MW parameters in the differentiation between the actual chemotherapy-related and afterload elevation-related alterations in GLS

Methods

Results

Conclusion