Utility of Echocardiography Screening for Cancer Therapy-Related Cardiac Dysfunction

Abstract

Availability of echocardiography resources in New Zealand is under pressure due to workforce shortages. This study examined real-world utility of echocardiogram (echo) as a screening tool for cancer therapy-related cardiac dysfunction (CTRCD), changes in patient treatment, and outcome because of CTRCD detected by echocardiography. A retrospective audit was undertaken of all patients dispensed with trastuzumab, pertuzumab, and/or doxorubicin chemotherapy, with serial echocardiography performed, at Lakes and Bay of Plenty District Health Boards between January 2018 and January 2021. Two-dimensional ejection fraction (EF), three-dimensional (3D) EF, and global longitudinal strain (GLS) were used to classify patients with CTRCD based on current guidelines. Changes in patient management were examined. A total of 407 echos were performed in 107 patients. Of 25 (23%) patients with CTRCD, 11 had a change in cancer treatment and seven started cardiac medications. Fifteen (60%) patients showed recovery in EF/GLS measurements over time and eight (32%) showed spontaneous recovery. Patients were more likely to have a change in cancer treatment based on a change in left ventricular ejection fraction than GLS (p<0.001). The use of 3D EF and GLS was limited by 43% of the population who were obese, which was performed in 14% and 62% of studies, respectively. Cancer therapy-related cardiac dysfunction was associated with mortality in univariate (p=0.02) but not multivariate (p=0.06) analysis. Detection of CTRCD remains a priority. However, echo screening requires many resources and did not result in consistent changes in management approach. It is worth examining whether the use of biomarkers would be effective and resource sparing.