Key result
Global work index at interim follow-up independently predicted cancer therapy-related cardiac dysfunction (OR 0.995) and demonstrated the best predictive value with an AUC of 0.817.
Why the study?
The study aimed to investigate the value of myocardial work parameters for the early identification of cancer therapy-related cardiac dysfunction.
Do myocardial work parameters predict early cancer therapy-related cardiac dysfunction in patients receiving cardiotoxic therapy?
Cohort (n=312)
No
Do myocardial work parameters predict early cancer therapy-related cardiac dysfunction in patients receiving cardiotoxic therapy?
Myocardial work parameters, particularly global work index, can detect left ventricular mechanical impairment before overt LVEF decline, enabling early identification of cancer therapy-related cardiac dysfunction.
May support GWI for early CTRCD risk stratification before LVEF decline; hypothesis-generating and requires prospective validation.
This study aimed to investigate the value of myocardial work (MW) parameters for the early identification of cancer therapy-related cardiac dysfunction (CTRCD) in an echocardiographic (ECHO) cohort. This retrospective study included 312 patients with malignant tumors [mean age 54.63 ± 10.28 years; 160 (51.28%) males] who received potentially cardiotoxic cancer therapy between January 2023 and November 2025. Patients were divided into CTRCD ( n = 78) and non-CTRCD groups ( n = 234). Serial ECHO assessments were performed at baseline (T0), interim follow-up (T1), and endpoint (T2). T1 was defined as the follow-up ECHO examination obtained before CTRCD diagnosis and was selected as the examination closest to baseline among available follow-up assessments that did not meet CTRCD diagnostic criteria. Clinical data, treatment-related factors, and ECHO parameters were collected. Global longitudinal strain (GLS) and MW parameters, including global work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE), were derived from speckle-tracking and pressure-strain loop analyses. Logistic regression analysis was performed to identify independent correlates of CTRCD. The predictive value of MW parameters for CTRCD was evaluated using receiver operating characteristic curves. At interim follow-up (T1, pre-CTRCD diagnosis), the CTRCD group showed significant reductions in GLS, GWI, GCW, and GWE, along with increased GWW (all p < 0.05), whereas left ventricular ejection fraction (LVEF) decreased only mildly. Non-CTRCD patients had no significant changes. Multivariable analysis identified GLS_T1 ( OR = 1.624, 95% CI : 1.284–2.053), GWI_T1 ( OR = 0.995, 95% CI : 0.993–0.997), GCW_T1 ( OR = 0.997, 95% CI : 0.995–0.998), and GWW_T1 ( OR = 1.016, 95% CI : 1.008–1.024) as independent correlates of CTRCD (all p < 0.001). GWI_T1 demonstrated the best predictive value (AUC = 0.817; 95% CI: 0.765–0.869), with an optimal cutoff of > 2,055 mmHg% yielding a sensitivity of 71.8% and a specificity of 76.9%. MW parameters detect left ventricular mechanical impairment before overt LVEF decline, enabling early CTRCD identification. GWI shows superior predictive discrimination and may enhance cardiotoxicity monitoring in cancer patients.
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Hui et al. (2026) conducted a cohort in Cancer therapy-related cardiac dysfunction (CTRCD) (n=312). Global work index at interim follow-up (GWI_T1) vs. Unexposed/reference group was evaluated on Cancer therapy-related cardiac dysfunction (CTRCD) (OR 0.995, 95% CI 0.993-0.997, p=<0.001). Global work index at interim follow-up independently predicted cancer therapy-related cardiac dysfunction (OR 0.995) and demonstrated the best predictive value with an AUC of 0.817.
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