The minimum clinically important change or difference in the 15D score representing overall HRQoL on a 0-1 scale is 0.015. Differences between and within hospitals were tested by independent and paired samples t-tests and linear regression with some background variables standardized. Results: At baseline, mean 15D score was in KUH (0.752) statistically significantly (p< 0.001) and clinically importantly lower than in VCH (0.831) or HUH (0.830). The mean six-month score was 0.858 in KUH, compared to 0.860 and 0.875 in VCH and HUH, respectively. With gender, age and baseline 15D score standardized, the mean six-month scores were 0.846, 0.879 and 0.877 in KUH, VCH and HUH, respectively and the differences between KUH and both other hospitals became statistically significant (p< 0.001) and clinically important. A clinically important HRQoL improvement was experienced by 85.8, 59.1 and 64.0% and a clinically important deterioration by 6.8, 25.3 and 22.1% in KUH, VCH and HUH, respectively. ConClusions: Treatment indication and effectiveness in terms of HRQoL, i.e., 15D score change and percentage of patients experiencing a clinically important improvement or deterioration, varied between hospitals. HRQoL measurements can be used to compare effectiveness of treatment between hospitals but for fair comparisons standardization of relevant baseline demographic and clinical parameters of patients is needed.
Background: Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing this complication. Left ventricle global longitudinal strain (LV-GLS) has been described as a sensitive parameter for detecting systolic dysfunction, even in the presence of preserved left ventricle ejection fraction (LVEF). Objective: to evaluate the role of the LV-GLS as a predictor of ChC. Methods: This study is a post-hoc analysis of CECCY trial (Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity) that evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population with breast cancer. Cardiotoxicity was defined as a reduction >10% in LVEF. LV-GLS was obtained before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results: Thirty-one patients who had a complete echocardiography study including measurement of LV-GLS before chemotherapy were included in this analysis. An absolute LV-GLS <16.9% before chemotherapy showed 100% sensitivity and 73% specificity for predicting cardiotoxicity (AUC=0.85; 95%CI 0.680 – 0.959, p<0.001). In this population, LVEF values before chemotherapy did not predict ChC (95%CI 0.478 to -0.842, p=0.17). The association of low LV-GLS (<17%) and BNP serum levels (>17 pg/mL) two months after chemotherapy increased the accuracy for detecting early onset ChC (100% sensitivity, 88% specificity, AUC=0.94; 95%CI 0.781 – 0.995, p<0.0001). Conclusions: Our data suggest that LV-GLS is a potential predictor of chemotherapy-induced cardiotoxicity. Larger studies are needed to confirm the relevance of this echocardiographic parameter in this clinical setting.
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