Phasic Left Atrial Function in Cancer Patients Before Initiation of Anti-Cancer Therapy.

Marijana Tadic,Martin Genger,Evgeny Belyavskiy,Aleksandar Dordevic,Jakob Völkl,Sabine Haßfeld,Daniel A Morris,Cesare Cuspidi,Abdul Shokor Parwani,Athanasios Frydas,Burkert Pieske

doi:10.3390/jcm8040421

Abstract

We aimed to explore left atrial (LA) remodeling in the patients with solid cancer before initiation of chemo- or radiotherapy. This retrospective investigation included 92 chemo- and radiotherapy-naive cancer patients and 40 age- and gender-matched controls with a similar cardiovascular risk profile as the cancer group. All participants underwent comprehensive echocardiographic examination before the start of chemo- or radiotherapy. LA phasic function was evaluated in volumetric and strain method. Indexed minimal and pre-A LA volumes were significantly higher in the cancer patients. Total and passive LA emptying fraction (EF) were significantly lower, whereas active LAEF was significantly higher in the cancer patients. LA total longitudinal strain was significantly lower in the cancer patients. Strain rate analysis of LA phasic function showed that LA function during systole and early diastole was reduced in the cancer group, while it was increased during late diastole. These findings indicated that LA reservoir and conduit functions, assessed with LA volumetric and strain analysis, were deteriorated in the cancer group. On the other hand, LA booster pump function was elevated in the cancer group in comparison with the controls. In the whole population, cancer was associated with reduced LA total longitudinal strain independently of age, gender, BMI, LV hypertrophy, E/e’ ratio, diabetes, and hypertension. LA phasic function was impaired in the chemo- and radiotherapy-naive cancer patients in comparison with the control group. Cancer, LV hypertrophy, and hypertension were associated with reduced LA longitudinal strain independently of other important clinical parameters.

Highlights

Left ventricular (LV) remodeling in the treated cancer patients has been confirmed in the large number of studies [1,2,3], and important is the incremental predictive value of LV changes in the cancer patients [3]
Considering the fact that left atrial (LA) function has an important implication with respect to outcomes in general population [10], the evaluation of LA phasic function in the cancer patients before anti-cancer treatment could be of importance due to the potential to discriminate LA remodeling induced by chemo- or radiotherapy from LA dysfunction that exists before treatment
Gender distribution, Body mass index (BMI), blood pressure, prevalence of hypertension, diabetes, and smoking was similar between the controls and the cancer patients (Table 1)

Summary

Introduction

Left ventricular (LV) remodeling in the treated cancer patients has been confirmed in the large number of studies [1,2,3], and important is the incremental predictive value of LV changes in the cancer patients [3]. Our study group recently showed that left and right ventricular functional impairment, in strain, was present in the cancer patients before anti-cancer therapy [4,5]. Considering the fact that LA function has an important implication with respect to outcomes in general population [10], the evaluation of LA phasic function in the cancer patients before anti-cancer treatment could be of importance due to the potential to discriminate LA remodeling induced by chemo- or radiotherapy from LA dysfunction that exists before treatment. LA enlargement and dysfunction before treatment initiation might be related with higher risk of cardiotoxicity in the later course of disease when therapy is applied. This hypothesis represents the rationale for this study

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