Baseline global longitudinal strain predictive of anthracycline-induced cardiotoxicity

Abstract

Background Cancer therapy-related cardiac dysfunction (CTRD) is a major source of morbidity and mortality in long-term cancer survivors. Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited. Objectives The purpose of this study was to investigate whether baseline echocardiographic assessment of global longitudinal strain (GLS) before treatment with anthracyclines is predictive of (CTRD) in a broad cohort of patients with normal baseline LVEF. Methods Study participants comprised 188 patients at a single institution who underwent baseline 2-dimensional (2D) speckle-tracking echocardiography before treatment with anthracyclines and at least one follow-up echocardiogram 3 months after chemotherapy initiation. Patients with a baseline LVEF <55% were excluded from the analysis. The primary endpoint, (CTRD), was defined as an absolute decline in LVEF > 10% from baseline and an overall reduced LVEF <50%. Potential and known risk factors were evaluated using univariable and multivariable Cox proportional hazards regression analysis. Results Twenty-three patients (12.23%) developed (CTRD). Among patients with (CTRD), the mean GLS was -17.51% ± 2.77%. The optimal cutoff point for (CTRD) was -18.05%. The sensitivity was 0.70 and specificity was 0.70. The area under ROC curve was 0.70. After adjustment for cardiovascular and cancer therapy related risk factors, GLS or decreased baseline GLS ≥-18% was predictive of (CTRD) (adjusted hazards ratio 1.17, 95% confidence interval 1.00, 1.36; p = 0.044 for GLS, or hazards ratio 3.54; 95% confidence interval 1.34, 9.35; p = 0.011 for decreased GLS), along with history of tobacco use, pre-chemotherapy systolic blood pressure, and cumulative anthracycline dose. Conclusions Baseline GLS or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline LVEF. This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD).

Current Status and Trends of Research on Anthracycline-Induced Cardiotoxicity from 2002 to 2021: A Twenty-Year Bibliometric and Visualization Analysis

“…A reduction in GLS of >15% from baseline is generally considered an early sign of heart failure. Recent studies that applied GLS to guide clinical decision-making have reduced the incidence of cancer therapy-related cardiac dysfunction [ 64 ]. Accordingly, GLS might be a preferred index for early detection of cardiotoxicity during ANT therapy.…”

Risk Factors for Anthracycline-Induced Cardiotoxicity

“…The process of study selection is presented in a PRISMA flow diagram (Figure 1). According to the inclusion and exclusion criteria, a total of 18 studies (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) were included for analysis. The detailed characteristics of these studies, including treatment regimens, patient population, primary endpoint, and number of patients are shown in Table 1.…”

Dihydroartemisinin alleviates doxorubicin‐induced cardiotoxicity and ferroptosis by activating Nrf2 and regulating autophagy

“…There are several limitations to our research. An assessment of segmental cardiac function and diastolic function contributes to determine the protective effect of DHA 37,38 . We assessed EF and FS, but we did not assess segmental cardiac function (strain, displacement vectors) and—ideally—diastolic function (E/A ratios in the mitral inflow).…”