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September 8, 2026BMC Cardiovascular Disorders0 citationsOpen Access

Early detection of cancer therapy-related cardiac dysfunction using myocardial work: a retrospective echocardiographic cohort study

RHRan HuiHebei Medical UniversityYZYuming ZhangHebei Medical UniversityZLZhe LiHebei Medical University

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.

Key Points

  • To investigate whether echocardiographic myocardial work parameters can identify cancer therapy-related cardiac dysfunction prior to overt functional decline.
  • Analyzed 312 patients with malignant tumors (mean age 54.63 ± 10.28 years; 160 males) receiving potentially cardiotoxic cancer therapy between January 2023 and November 2025, divided into CTRCD (n = 78) and non-CTRCD (n = 234) groups.
  • Performed serial echocardiograms at baseline (T0), interim follow-up before CTRCD diagnosis (T1), and endpoint (T2) to measure global longitudinal strain and myocardial work indices via pressure-strain loop analysis.
  • At pre-diagnosis follow-up (T1), the CTRCD group demonstrated significant decreases in global longitudinal strain, global work index (GWI), constructive work (GCW), and work efficiency, alongside increased wasted work (GWW) (all p < 0.05), despite only mild left ventricular ejection fraction reduction.
  • Multivariable logistic regression identified GLS (OR = 1.624, 95% CI: 1.284–2.053), GWI (OR = 0.995, 95% CI: 0.993–0.997), GCW (OR = 0.997, 95% CI: 0.995–0.998), and GWW (OR = 1.016, 95% CI: 1.008–1.024) at T1 as independent correlates of CTRCD (all p < 0.001).
  • GWI at T1 showed the highest predictive accuracy for CTRCD (AUC = 0.817, 95% CI: 0.765–0.869; cutoff > 2,055 mmHg% yielding 71.8% sensitivity and 76.9% specificity).

Study Design

Type

Cohort (n=312)

Multicenter

No

Structured PICO

Do myocardial work parameters predict early cancer therapy-related cardiac dysfunction in patients receiving cardiotoxic therapy?

P
Population
312 adult patients with malignant tumors receiving potentially cardiotoxic cancer therapy, followed for a median of 10 months to evaluate echocardiographic predictors of cardiac dysfunction.
E
Exposure
Echocardiographic assessment of myocardial work (MW) parameters (global work index, constructive work, wasted work, and work efficiency) and global longitudinal strain (GLS)
C
Comparator
Patients who did not develop cancer therapy-related cardiac dysfunction (non-CTRCD group, n=234)
O
Outcome
Early identification of cancer therapy-related cardiac dysfunction (CTRCD)surrogate

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.

Main Result

Odds Ratio: 0.995 (95% CI 0.993–0.997)

p-value: p=<0.001

Limitations

  • Single-center retrospective design is inherently susceptible to selection and information bias.
  • ECHO assessments were derived from routine clinical practice rather than a strictly predefined prospective schedule, introducing potential time-dependent bias.
  • Myocardial work calculation depends on the quality of blood pressure measurement and strain tracking.
  • CTRCD was defined solely using the LVEF criterion, potentially missing other cardiotoxicity phenotypes.
  • Lack of comprehensive model evaluation, including external validation and clinical decision curve analysis.

Abstract

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 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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Cite This Study

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.

synapsesocial.com/papers/6a9fd80458e84d0ff5b471adhttps://doi.org/10.1186/s12872-026-06579-x
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