Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity

Charbonnel, C.; Convers-Domart, R.; Rigaudeau, Sophie; Taksin, Anne‐Laure; Baron, N.; Lambert, Juliette; Ghez, Stéphanie; Georges, Jean-Louis; Farhat, H.; Lambert, Jérôme; Rousselot, Philippe; Livarek, B.

doi:10.1093/ehjci/jew223

Cited by 70 publications

(71 citation statements)

References 30 publications

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“…Previous studies on the sensitivity of GLS in monitoring anthracycline-induced myocardial damage showed that when the average cumulative dose was 60 mg/m 2 , GLS did not decrease significantly, 19 and when the average cumulative dose was 266 mg/m 2 (200-298 mg/m 2 ), GLS decreased significantly. 20 The results of our study showed that when the cumulative dosage of anthracycline was <160 mg/m 2 , GLS showed a significant decrease. To the best of our knowledge, no studies have detected a significant GLS decrease with a lower dose of anthracycline than one used in the current study.…”

Section: Discussionmentioning

confidence: 53%

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anqi

Zhang

et al. 2019

Echocardiography

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Background Anthracycline‐related cardiotoxicity has a poor prognosis; therefore, early detection of any change in LV function is critical. Objective The aim of this study was to evaluate the two‐dimensional speckle tracking technique for the early detection of cardiac toxicity after low‐dose anthracycline chemotherapy in the Chinese population. Methods Forty breast cancer patients were treated by chemotherapy using anthracycline for 4–6 cycles. Patients were examined by echocardiography before chemotherapy (T0) and after the second (T2), fourth (T4), and sixth (T6) cycle. LV ejection fraction (LVEF), LV global longitudinal strain (GLS) and endocardium, mid‐myocardium, and epicardium global longitudinal strain (GLS‐Endo, GLS‐Mid, and GLS‐Epi). Additionally, global circumferential strain (GCS), RV global longitudinal strain (RVGLS), and LA global longitudinal strain (LAGLS) were evaluated. Results Left ventricular ejection fraction was significantly reduced at T4 (P < 0.05). Compared with T0, GLS, GLS‐Endo, GLS‐Mid, and GLS‐Epi were significantly reduced at T2, T4, and T6 (P < 0.05 for all), the apical septum wall (AS) was also reduced significantly at T2 (P < 0.05), and the apical anterior wall (AA) and the basal anterior wall (BA) longitudinal strains were significantly reduced at T4 (P < 0.05). GCS, RVGLS, and LAGLS were not significantly changed after treatment (P > 0.05). Conclusions LV stratified strains and strain of the segments supplied by the left anterior descending coronary artery are more sensitive to the cardiac toxicity of anthracycline.

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Section: Discussionmentioning

confidence: 53%

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anqi

Zhang

et al. 2019

Echocardiography

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“…GLS, which detects early changes in myocardial contractile function, has been used to monitor for cardiotoxicity caused by antineoplastic agents in patients receiving anthracyclines and/or trastuzumab. [21][22][23] GLS has been utilized for early screening of cardiomyopathy and/or heart failure in patients receiving anti-neoplastic agents. There are limited GLS data on patients receiving ICIs.…”

Section: Discussionmentioning

confidence: 99%

Cardiotoxicity associated with immune checkpoint inhibitors: A retrospective analysis of patients at an academic tertiary care center

Waheed

Fradley

DeRemer

et al. 2020

Preprint

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Background: Immune checkpoint inhibitors (ICIs) are a novel class of anticancer agents that have demonstrated clinical response for both solid and hematological malignancies. ICIs are associated with development of immune-related adverse events including cardiotoxicity. We estimated the incidence of ICI-related cardiotoxicity in patients treated with ICIs at a large, tertiary care center.Methods: All patients with a cancer diagnosis who received any ICI treatment in the University of Florida’s Integrated Data Repository from 2011-2017 were included. Cardiotoxicity was defined as a new ICD diagnosis code for cardiomyopathy, heart failure, arrhythmia, heart block, pericardial disease, or myocarditis after initiation of ICI treatment.Results: Of 102,701 patients with a diagnosis of malignancy, 424 patients received at least one ICI. Sixty-two (14.6%) patients were diagnosed with at least one possible form of cardiotoxicity after initiation of ICI therapy. Of the 374 patients receiving one ICI, 21 (5.6%) developed heart failure. Of the 49 patients who received two ICIs sequentially, three (6.1%) developed heart failure and/or cardiomyopathy. Cardiotoxicity was diagnosed at a median of 63 days after initial ICI exposure. One patient developed myocarditis 28 days after receiving nivolumab. Mortality in those who developed ICI-attributable cardiotoxicity was higher compared to those who did not (66.1% vs. 41.4%, odds ratio=2.77, 1.55-4.95, p=0.0006). There was no evidence that use of cardioprotective agents such as beta-blockers or statins was associated with lower rates of cardiotoxicity or mortality.Conclusions: This study suggests that the incidence of ICI-related cardiotoxicity may be higher than previously reported.

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“…ФВ ЛЖ, по сути, отражает лишь изменения объема ЛЖ во время систолы, но не учитывает структурных изменений, которые происходят на уровне миокарда, поэтому все больше значения приобретают методы, позволяющие верифицировать субклиническое снижение функции ЛЖ. К ним относится и оценка глобальной продольной деформации (Global Longitudinal Strain, GLS) ЛЖ, которая, являясь более воcпроизводимой методикой по сравнению с оценкой ФВ ЛЖ, удобна для клинического применения [6]. Большая часть продольно ориентированных волокон расположена в субэндокардиальном слое, который наиболее чувствителен к повреждению.…”

Section: клиника и фармакотерапияunclassified

Myocardial contractility dysfunction in patients with chronic lymphocytic leukemia receiving chemotherapy and their treatment with enalapril

et al. 2020

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90Особенности нарушения сократительной способности миокарда у больных хроническим лимфолейкозом в процессе химиотерапии и их коррекция эналаприлом Давыдкин И. Л., Кузьмина Т. П., Золотовская И. А., Терешина О. В., Данилова О. Е., Хайретдинов Р. К., Рогозина Л. А.Цель. Оценка нарушений сократительной способности левого желудочка (ЛЖ) в процессе химиотерапии по схеме FCR (флударабин, циклофосфамид, ритуксимаб) у пациентов с хроническим лимфолейкозом (ХЛЛ) и эффективности их коррекции эналаприлом. Материал и методы. В исследование вошли 49 пациентов с впервые выявленным ХЛЛ стадии В по Вinet в сочетании со стабильной стенокардией напряжения (ССН) I-II функционального класса (ФК), артериальной гипертензией 1-2-й степени и фракцией выброса (ФВ) ЛЖ >50%, которые не принимали препараты из группы ингибиторов ангиотензинпревращающего фермента (иАПФ), не имели клинических признаков сердечной недостаточности (СН) и у всех показания к лечению по схеме FCR были до его начала. Пациенты прошли двухмерную эхокардиографию (ЭхоКГ) исходно, до начала полихимиотерапии (ПХТ) (период V 1 ) и после трех (84±5 дней) (V 2 ) и шести (168±7 дней) (V 3 ) курсов ПХТ. На V 2 пациенты были разделены на две группы. К лечению в основной группе была добавлена кардиопротективная терапия (эналаприл). Результаты. После третьего курса ПХТ отмечено относительное процентное снижение глобальной продольной деформации (Global Longitudinal Strain, GLS) в основной и контрольной группах -на 16, 16±0,80 и 16,2±0,79, соответственно (р=0,764), что является предиктором кардиотоксичности. При этом показатель ФВ ЛЖ (%) оставался в пределах нормального диапазона: 63,4 [65; 68] в основной группе и 63,9 [61,6; 67] в группе контроля (р=0,960). После шестого курса ПХТ показатели ФВ ЛЖ достоверно различались (р=0,002): в группе контроля у пяти пациентов (21%) зафиксировано развитие кардиотоксичности, которая отсутствовала в основной группе. Заключение. Клинически значимое снижение GLS является маркером субклинической сократительной дисфункции ЛЖ с прогнозируемым развитием кардиотоксичности у пациентов с ХЛЛ в процессе химиотерапевтического лечения по схеме FCR. Своевременное добавление к лечению эналаприла позволяет предотвратить развитие кардиотоксичности у таких пациентов. Доказана необходимость ранней оценки GLS во время курсов терапии по схеме FCR для выявления и предупреждения кардиотоксичности.Ключевые слова: хронический лимфолейкоз, субклиническая сократительная дисфункция левого желудочка, кардиотоксичность, химиотерапия, эналаприл.

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Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity

Abstract: GLS greater than -17.45%, obtained after 150 mg/m2 of anthracycline therapy, is an independent predictor of future anthracycline-induced cardiotoxicity. These findings should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.

Cited by 70 publications

References 30 publications

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Cardiotoxicity associated with immune checkpoint inhibitors: A retrospective analysis of patients at an academic tertiary care center

Myocardial contractility dysfunction in patients with chronic lymphocytic leukemia receiving chemotherapy and their treatment with enalapril

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