Baseline Electrocardiographic and Echocardiographic Assessment May Help Predict Survival in Lung Cancer Patients—A Prospective Cardio-Oncology Study

Abstract

Cardiovascular disease and cancer coexist and lead to exertional dyspnea. The aim of the study was to determine the prognostic significance of cardiac comorbidities, ECG and baseline echocardiography in lung cancer patients with varying degrees of reduced performance status. This prospective study included 104 patients with histopathologically confirmed lung cancer, pre-qualified for systemic treatment due to metastatic or locally advanced malignancy but not eligible for thoracic surgery. The patients underwent a comprehensive cardio-oncological evaluation. Overall survival negative predictors included low ECOG 2 (Eastern Cooperative Oncology Group) performance status, stage IV (bone or liver/adrenal metastases in particular), pleural effusion, the use of analgesics and among cardiac factors, two ECG parameters: atrial fibrillation (HR = 2.39) and heart rate >90/min. (HR = 1.67). Among echocardiographic parameters, RVSP > 39mmHg was a negative predictor (HR = 2.01), while RVSP < 21mmHg and RV free wall strain < −30% were positive predictors (HR = 0.36 and HR = 0.56, respectively), whereas RV GLS <−25.5% had a borderline significance (HR = 0.59; p =0.05). Logistical regression analysis showed ECOG = 2 significantly correlated with the following echocardiographic parameters: increasing RVSP, RV GLS, RV free wall strain and decreasing ACT, FAC (p < 0.05). Selected echocardiographic parameters may be helpful in predicting poor performance in lung cancer patients and, supplemented with ECG evaluation, broaden the possibilities of prognostic evaluation.

Characteristics of patients with newly diagnosed hematological malignancies referred for echocardiography

“…To a large extent, in terms of many anticancer drugs, this stratification is based on the result of echocardiography, although clinical diagnoses are also of integral importance ( 9 ). It should be emphasized that the initial risk stratification has its prognostic justification ( 11 , 22 ).…”

Are cardiovascular comorbidities always associated with a worse prognosis in patients with lung cancer?

“…The impact of cardiovascular comorbidities on prognosis is limited in advanced stages of lung cancer. Cardiac arrhythmias (especially atrial fibrillation) and echocardiographic changes suggesting the development of pulmonary hypertension (right ventricular systolic pressure increase) and dysfunction of the right ventricle rather result from the advancement of neoplastic disease, correlate with decreased performance status and predict shorter overall survival (Figure 1) (7).…”

“…Poor prognosis has been demonstrated in patients undergoing thoracic surgery for lung cancer who developed AF: increased hospital mortality (6.7 vs. 1.0%, p = 0.024) and higher long-term mortality (HR = 3.75) (27). A significant negative prognostic value of AF (HR = 2.39 for mortality, p = 0.02) in lung cancer patients qualified for systemic cancer treatment has also been demonstrated (7).…”

“…occurring during cancer treatment is associated with an increase in cardiovascular events and mortality over a 10-year period (32). The prospective study in lung cancer demonstrated the prognostic significance of heart rate, regardless of whether it was sinus rhythm or atrial fibrillation, heart rate > 90/min predicted a higher risk of mortality (HR = 1.67; p = 0.03) (7). The tumor growth effect can be considered a potential explanation, as shorter survival was also observed in patients with right ventricular systolic pressure (RVSP) higher than 39 mmHg (HR = 2.01; p = 0.0045).…”

“…In patients with NSCLC, cardiovascular (CV) comorbidities, including coronary artery disease, hypertension, arrhythmias, and peripheral arteriosclerosis, increased the risk of death by 30% compared to patients without these conditions (6). However, some studies have shown no direct effect of concomitant diseases on overall survival (OS) in lung cancer in advanced inoperable stage (7). Retrospective cohort studies have shown that cancer-related mortality rates for biologically aggressive malignancies exceed those for comorbidities (8,9).…”