Key result
Active cancer is associated with augmented myocardial strain and altered CMR phenotypes vs healthy controls.
Why the study?
Whether active malignancy itself influences chamber volumes, function, or myocardial tissue health remains uncertain, as emphasis has primarily focused on cancer therapeutics.
Does the presence of active, chemotherapy-naïve cancer alter cardiac chamber size, function, and tissue health compared to healthy volunteers?
Cohort (n=483)
No
Does the presence of active, chemotherapy-naïve cancer alter cardiac chamber size, function, and tissue health compared to healthy volunteers?
Active malignancy inherently alters the cardiac phenotype, highlighting that cancer therapies are introduced into a cardiovascular system already affected by the disease process itself.
Active cancer may alter baseline cardiac phenotyping before therapy; leaves open whether changes predict cardiotoxicity or warrant adjusted monitoring.
Background The overlap between cancer and cardiovascular care continues to expand, with intersections emerging before, during, and following cancer therapies. To date, emphasis has been placed on how cancer therapeutics influence downstream cardiac health. However, whether active malignancy itself influences chamber volumes, function, or overall myocardial tissue health remains uncertain. We sought to perform a comprehensive cardiovascular magnetic resonance-based evaluation of cardiac health in patients with chemotherapy-naïve cancer with comparison with a healthy volunteer population. Methods and Results Three-hundred and eighty-one patients with active breast cancer or lymphoma before cardiotoxic chemotherapy exposure were recruited in addition to 102 healthy volunteers. Both cohorts underwent standardized cardiovascular magnetic resonance imaging with quantification of chamber volumes, ejection fraction, and native myocardial T1. Left ventricular mechanics were incrementally assessed using three-dimensional myocardial deformation analysis, providing global longitudinal, circumferential, radial, and principal peak-systolic strain amplitude and systolic strain rate. The mean age of patients with cancer was 53.8±13.4 years; 79% being women. Despite similar left ventricular ejection fraction, patients with cancer showed smaller chambers, increased strain amplitude, and systolic strain rate in both conventional and principal directions, and elevated native T1 versus sex-matched healthy volunteers. Adjusting for age, sex, hypertension, and diabetes mellitus, the presence of cancer remained associated with these cardiovascular magnetic resonance parameters. Conclusions The presence of cancer is independently associated with alterations in cardiac chamber size, function, and objective markers of tissue health. Dedicated research is warranted to elucidate pathophysiologic mechanisms underlying these findings and to explore their relevance to the management of patients with cancer referred for cardiotoxic therapies.
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Labib et al. (2021) conducted a cohort in Active chemotherapy-naïve breast cancer or lymphoma (n=483). Presence of active, chemotherapy-naïve cancer vs. Healthy volunteers was evaluated on Global maximum principal strain amplitude (CMR myocardial deformation) (Adjusted B 9.98, 95% CI 2.70-17.25, p=0.007). Active cancer is independently associated with alterations in cardiac chamber size, augmented contractility (elevated strain), and elevated native myocardial T1 compared with healthy volunteers.
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