Left Ventricular Strain in Chemotherapy-Naive and Radiotherapy-Naive Patients With Cancer

Tadić, Marijana; Genger, Martin; Baudisch, Ana; Kelle, Sebastian; Cuspidi, Cesare; Belyavskiy, Evgeny; Burkhardt, F.; Venneri, Lucia; Attanasio, Philipp; Pieske, Burkert

doi:10.1016/j.cjca.2017.11.018

Cited by 31 publications

(28 citation statements)

References 30 publications

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“…Tadic et al have recently published their research findings of abnormal left ventricular (LV) systolic function in 122 chemotherapy naïve and radiotherapy naïve cancer patients (prechemotherapy) and 45 age‐matched controls. They reported significant abnormality in LV systolic function in cancer patients compared to controls and reported a decrease in LV global longitudinal strain, (19.1 ± 2.1% vs 17.8 ± 3.5%, P ‐ .022), LV global circumferential strain, (22.9 ± 3.5% vs 20.1 ± 4.1%, P < .001), and LV global radial strain, (40.5 ± 8.8% vs 35.2 ± 10.7%; P ‐ .004) . These finding are similar to findings in our study population where we have found significant abnormalities LV systolic function as assessed by speckle strain imaging in prechemotherapy group compared to normal group.…”

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confidence: 79%

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

et al. 2020

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We would like to thank Dr Tadic and colleague for their interest in our research manuscript titled "Pediatric Malignancies: Is the Pre-chemotherapy Left Ventricular Function Normal?" 1 and their contribution in the research related to chemotherapy-induced cardiomyopathy. Tadic et al have recently published their research findings of abnormal left ventricular (LV) systolic function in 122chemotherapy naïve and radiotherapy naïve cancer patients (prechemotherapy) and 45 age-matched controls. They reported signifition exists, which can be detected by the speckle tracking echocardiography. As more and more research data are being published, we propose adding the speckle echocardiography for assessing the LV systolic function in patients even before they have received chemotherapy. This may help stratify high-risk patients who are at risk for chemotherapy and radiotherapy induced cardiotoxicity.Jyothsna Akam-Venkata MBBS

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confidence: 79%

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

et al. 2020

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“…In accordance with the results of this study, Pavo et al (22) found that myocardial damage was directly linked to cancer, and myocardial damage biomarkers were upregulated in cancer patients who did not undergo cardiotoxic therapies. Likewise, a retrospective study revealed that cancer patients without CT or RT had a higher risk of cardiac dysfunction than the age-and gender-matched controls (12). However, these studies were limited due to small sample size, whereas this study included large-scale and multicenter cases.…”

Section: Discussionmentioning

confidence: 96%

“…A single-center study supported this possibility and found decreased cardiac function among cancer patients not exposed to CT or RT. (12) Another study also revealed that tumors could directly induce cardiovascular damage by tumor-induced in ammation in tumor-bearing mice (13). The cardiotoxicity of CT and RT in breast cancer patients is con rmed, but it remains elusive whether avoiding CT and/or RT regimens lower or increase CVD risk in breast cancer survivors.…”

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confidence: 99%

Increased risk of cardiovascular death in breast cancer patients without chemotherapy or (and) radiotherapy: a large population-based study.

Guan

Zhang

Yang

et al. 2020

Preprint

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Background Cardiovascular death (CVD) in breast cancer patients without chemotherapy or (and) radiotherapy has not been studied yet. This study evaluates the correlation between breast cancer and CVD risk independent of chemotherapy (CT) or (and) radiotherapy (RT). Methods Data of female breast cancer patients without receiving CT or RT were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database (2004–2015). Data were divided into two cohorts: Patients who underwent tumor resection (resection cohort) and those who didn’t undergo resection (no resection cohort). The CVD risk in patients was expressed as standardized mortality ratios (SMRs). A 1:1 propensity score matching (PSM) was applied to balance inter-group bias, and competing risk regressions were utilized to evaluate the impact of tumor resection on CVD. Results The CVD risk was significantly higher (SMR = 2.196, 95% CI:2.148–2.245, P < 0.001) in breast cancer patients who did not receive CT or RT compared to the general population. Breast cancer patients who did not undergo tumor resection showed a higher CVD risk than patients who underwent tumour resection (tumor resection SMR = 2.031, 95% CI: 1.983–2.079, P < 0.001; no resection SMR = 5.425, 95% CI:5.087–5.781, P < 0.001). After PSM, the CVD risk among patients without tumor resection indicated an increase of 1.165-fold compared to the patients with tumor resection (HR = 1.165, 95% CI: 1.039–1.306, P = 0.009). Conclusions Female breast cancer patients are at higher risk of CVD despite unexposure to cardio-toxic CT or RT. However, female breast cancer patients subjected to tumor resection have decreased CVD risk. This study suggests that monitoring female breast cancer patients not receiving RT or CT might serve as a preventative measure against CVD.

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“…LV circumferential and radial strains were not assessed in this study. 4,5 The difference existed not only in the global values of LV and RV strains, but also in layer-specific strain, which further implies transmural myocardial and not endocardial impairment, as it was usually presumed. Mavinkurve-Groothuis et al reported a significant reduction in LV longitudinal, circumferential, and radial strains in the children with acute lymphoblastic leukemia after anthracycline therapy than before treatment.…”

Section: Left Ventricular Dysfunction Before Chemotherapy: Did We Mismentioning

confidence: 94%

“…3 Our research group recently published studies in which it was shown not only that LV multidirectional strain (longitudinal, circumferential, and radial) was significantly decreased in chemotherapy-and radiotherapy-naïve patients with solid cancer, but also that right ventricular (RV) longitudinal strain was significantly reduced in the cancer patients in comparison with controls. 4,5 The difference existed not only in the global values of LV and RV strains, but also in layer-specific strain, which further implies transmural myocardial and not endocardial impairment, as it was usually presumed.…”

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confidence: 94%

Left ventricular dysfunction before chemotherapy: Did we miss something?

Tadić

Cuspidi

2019

Echocardiography

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We have read with a great interest the article by Akam-Venkata et al regarding left ventricular (LV) function and mechanics in pediatric patients who still did not receive chemotherapy. 1 The investigators included pediatric patients with various malignancies and compared them with healthy children. The results showed that LV longitudinal strain was significantly lower in chemotherapy-naïve young patients than in healthy children despite similar values of LV ejection fraction, myocardial performance index, and shortening fraction. 1 The data were same for solid and hematological tumors. LV circumferential and radial strains were not assessed in this study. This is very important topic, which has not been sufficiently investigated so far. Mavinkurve-Groothuis et al reported a significant reduction in LV longitudinal, circumferential, and radial strains in the children with acute lymphoblastic leukemia after anthracycline therapy than before treatment. 2 Even though the researchers did not make statistical comparison in LV mechanics between healthy controls and cancer patients before chemotherapy, it was clear that LV longitudinal and circumferential strains were remarkably lower and that LV radial strain was remarkably higher, in the children with leukemia before chemotherapy than in healthy children. 2 In the adult population were obtained similar results. Assuncao et al in the adult patients with acute leukemia found significantly lower values of LV longitudinal strain than in healthy controls. 3 Our research group recently published studies in which it was shown not only that LV multidirectional strain (longitudinal, circumferential, and radial) was significantly decreased in chemotherapy-and radiotherapy-naïve patients with solid cancer, but also that right ventricular (RV) longitudinal strain was significantly reduced in the cancer patients in comparison with controls. 4,5 The difference existed not only in the global values of LV and RV strains, but also in layer-specific strain, which further implies transmural myocardial and not endocardial impairment, as it was usually presumed.The most important question that has been imposed from these studies is the potential mechanism(s) of this relationship. Why and how cancer could interfere cardiac function? All mentioned investigations showed that conventional parameters of LV and RV systolic function were similar between cancer patients and controls. On the other hand, all researches agree that mechanical function was deteriorated in the cancer patients independently of their age. There are several speculations on this topic: increased inflammation, elevated vasoactive peptides (endothelin, copeptin), pro-BNP, pro-ANP, and troponin T, impaired oxidative stress, or even direct infiltration of the myocardium by circulating cancer cells. To our knowledge, there are no studies designed to answer the questions regarding mechanisms responsible for cardiac dysfunction in the cancer patients. Considering the fact that most of the cancer patients are treated with cardioto...

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Left Ventricular Strain in Chemotherapy-Naive and Radiotherapy-Naive Patients With Cancer

Cited by 31 publications

References 30 publications

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

Increased risk of cardiovascular death in breast cancer patients without chemotherapy or (and) radiotherapy: a large population-based study.

Left ventricular dysfunction before chemotherapy: Did we miss something?

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