Purpose: To assess the ability of global longitudinal strain (GLS) with cardiovascular magnetic resonance imaging (CMR) to detect cancer therapy-related cardiac dysfunction (CTRCD) and predict heart failure symptoms. Methods: Breast cancer patients who had undergone CMR for monitoring of left ventricular (LV) function while receiving Trastuzumab were retrospectively recruited. Baseline LV volumes and GLS before commencement of Trastuzumab were compared with follow-up scans at 3, 6, 9, and 12 months. CTRCD was determined using either the GLS criteria (defined as >5% absolute reduction or >12% relative reduction of GLS) or ejection fraction (EF) criteria (defined as >10% absolute reduction to <50% or >20% absolute reduction from baseline values). The primary outcome was patient reported heart failure symptoms within one year. Results: Thirty female breast cancer patients with a mean age of 64±10 years were recruited. Both GLS (20.2±3.1% vs 23.0±3.0%, p<0.001) and EF (61.9±5.7% vs 66.0±6.0%, p<0.001) declined at 3 months compared to baseline and remained low until 12 months. Nine participants (30%) developed heart failure symptoms within one year. More CTRCD was diagnosed using GLS compared to EF criteria (67% vs 10%, p<0.001). The sensitivity and specificity to predict HF symptoms at 1-year were 78% and 35% for GLS, and 11% and 91% for EF, respectively. Conclusion: Both GLS and EF declined as early as 3 months after receiving Trastuzumab. GLS has greater sensitivity than EF to predict heart failure symptoms at 1-year. GLS assessment in cardiac CMR surveillance during chemotherapy may provide earlier detection of subclinical heart failure than using EF alone.
Objective: We aimed to study the long-term association of LV mass index (LVMI) and myocardial fibrosis with ventricular arrhythmia (VA) in a population of patients with confirmed hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance imaging (CMR). Methods: We retrospectively analyzed the data in consecutive HCM patients confirmed on CMR referred to an HCM clinic between January 2008 and October 2018. Patients were followed up yearly following diagnosis. Baseline demographics, risk factors and clinical outcomes from cardiac monitoring and an implanted cardioverter defibrillator (ICD) were analyzed for association of LVMI and LV late gadolinium enhancement (LVLGE) with VA. Patients were then allocated to one of two groups according to the presence of VA (Group A) or absence of VA (Group B) during the follow-up period. The transthoracic echocardiogram (TTE) and CMR parameters were compared between the two groups. Results: A total of 247 patients with confirmed HCM (age 56.2 ± 16.6, male = 71%) were studied over the follow-up period of 7 ± 3.3 years (95% CI = 6.6–7.4 years). LVMI derived from CMR was higher in Group A (91.1 ± 28.1 g/m2 vs. 78.8 ± 28.3 g/m2, p = 0.003) when compared to Group B. LVLGE was higher in Group A (7.3 ± 6.3% vs. 4.7 ± 4.3%, p = 0.001) when compared to Group B. Multivariable Cox regression analysis showed LVMI (hazard ratio (HR) = 1.02, 95% CI = 1.001–1.03, p = 0.03) and LVLGE (HR = 1.04, 95% CI = 1.001–1.08, p = 0.04) to be independent predictors for VA. Receiver operative curves showed higher LVMI and LVLGE with a cut-off of 85 g/m2 and 6%, respectively, to be associated with VA. Conclusions: LVMI and LVLGE are strongly associated with VA over long-term follow-up. LVMI requires more thorough studies to consider it as a risk stratification tool in patients with HCM.
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