Key result
Platinum chemotherapy in cancer survivors linked to ~3% lower LVEF and myocardial alterations versus controls.
Why the study?
Long-term toxicities of germ cell cancer treatment are of particular importance in young men with decades of life expectancy, but the long-term effects of platinum-based chemotherapy on cardiac function and myocardial tissue were unclear.
Does prior platinum-based chemotherapy cause long-term cardiotoxicity, including impaired systolic function and tissue alterations, in asymptomatic germ cell cancer survivors?
Case-Control (n=65)
No
Does prior platinum-based chemotherapy cause long-term cardiotoxicity, including impaired systolic function and tissue alterations, in asymptomatic germ cell cancer survivors?
Absolute Event Rate: 56% vs 59%
p-value: p=0.017
Platinum-based chemotherapy is associated with long-term subclinical biventricular systolic dysfunction and myocardial tissue alterations in asymptomatic germ cell cancer survivors.
May support cardiac surveillance in asymptomatic survivors; hypothesis-generating and requires prospective validation.
OBJECTIVES: Long-term toxicities of germ cell cancer (GCC) treatment are of particular importance in young men with a life expectancy of several decades after curative treatment. This study aimed to investigate the long-term effects of platinum-based chemotherapy on cardiac function and myocardial tissue in GCC survivors by cardiac magnetic resonance (CMR) imaging. METHODS: Asymptomatic GCC survivors ≥ 3 years after platinum-based chemotherapy and age-matched healthy controls underwent CMR assessment, including left ventricular (LV) and right ventricular (RV) ejection fraction (EF), strain analysis, late gadolinium enhancement (LGE) imaging, and T1/T2 mapping. RESULTS: Forty-four survivors (age 44 [interquartile range, IQR 37-52] years; follow-up time 10 [IQR 5-15] years after chemotherapy) and 21 controls were evaluated. LV- and RVEF were lower in GCC survivors compared to controls (LVEF 56 ± 5% vs. 59 ± 5%, p = 0.017; RVEF 50 ± 7% vs. 55 ± 7%, p = 0.008). Seven percent (3/44) of survivors showed reduced LVEF (< 50%), and 41% (18/44) showed borderline LVEF (50-54%). The strain analysis revealed significantly reduced deformation compared to controls (LV global longitudinal strain [GLS] -13 ± 2% vs. -15 ± 1%, p < 0.001; RV GLS -15 ± 4% vs. -19 ± 4%, p = 0.005). Tissue characterization revealed focal myocardial fibrosis in 9 survivors (20%) and lower myocardial native T1 times in survivors compared to controls (1202 ± 25 ms vs. 1226 ± 37 ms, p = 0.016). Attenuated LVEF was observed after two cycles of platinum-based chemotherapy (54 ± 5% vs. 62 ± 5%, p < 0.001). CONCLUSION: is associated with attenuated biventricular systolic function and myocardial tissue alterations in asymptomatic long-term GCC survivors. CLINICAL RELEVANCE STATEMENT: Platinum-based chemotherapy is associated with decreased systolic function, non-ischemic focal myocardial scar, and decreased T1 times in asymptomatic long-term germ cell cancer survivors. Clinicians should be particularly aware of the risk of cardiac toxicity after platinum-based chemotherapy. KEY POINTS: . • Cardiac MRI can help to identify chemotherapy-associated changes in cardiac function and tissue in asymptomatic long-term germ cell cancer survivors.
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Beitzen‐Heineke et al. (2023) conducted a case-control in Germ cell cancer (n=65). Platinum-based chemotherapy vs. Age-matched healthy controls was evaluated on Left ventricular ejection fraction (LVEF) (p=0.017). Platinum-based chemotherapy in germ cell cancer survivors was associated with reduced left ventricular ejection fraction (56% vs. 59%, p=0.017) and myocardial tissue alterations compared to healthy controls.
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