Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients.

Mariana Sardinha,Madalena Coutinho Cruz,António Gonçalves,Isabel Cardoso,Diana Simão,Luís Almeida-Morais,Luísa Moura Branco,Tania Branco Mano,Alexandra Castelo,Rui Cruz Ferreira,Pedro Garcia Brás,Ana Galrinho,Ana Timóteo,Vera Vaz Ferreira

doi:10.3390/ijerph19052826

Abstract

Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4–6 and 12–14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4–6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.

Highlights

This study is a part of a single-centre project (INV 308) that was approved by the ethics committee of the involved institution
The majority was treated with anthracyclines (77.0%), with a mean cumulative dose of
Myocardial work parameters—global myocardial work index (GWI), global constructive work (GCW), GWW and Global work efficiency (GWE)—compared to baseline; Twelve months after starting therapy, myocardial work (MW) indices tended to return to baseline values, not completely; More than one cardiovascular risk factor, obesity and baseline left atrium (LA) volume were predictors of MW parameters variation

Summary

Introduction

Breast cancer is one of the most common cancers worldwide, representing 11.7% of all new cancer cases and 6.9% of all deaths from cancer in 2020 [1]. Substantial advances in cancer therapies in the last decades have reshaped the prognosis of cancer patients [2]. Increased survival along with aging of the cancer population, which is associated with a greater burden of co-morbidities, has been accompanied by a rise in adverse cardiovascular complications, when there are pre-existing cardiovascular diseases [3–5]. The incidence of cardiotoxicity continues to grow, which can compromise the effectiveness of cancer therapy [2].

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Conclusion