Key result
Decreased baseline GLS linked to ~254% greater risk of anthracycline-induced cardiotoxicity despite normal LVEF.
Why the study?
Although decreased GLS predicts reduced LVEF during anthracyclines, knowledge regarding the clinical utility of baseline GLS for predicting CTRD in patients at low risk is limited.
Does baseline global longitudinal strain predict cancer therapy-related cardiac dysfunction in cancer patients with normal baseline LVEF receiving anthracyclines?
Cohort (n=188)
No
Does baseline global longitudinal strain predict cancer therapy-related cardiac dysfunction in cancer patients with normal baseline LVEF receiving anthracyclines?
Hazard Ratio: 3.54 (95% CI 1.34–9.35)
p-value: p=0.011
Baseline global longitudinal strain assessment before anthracycline therapy can identify patients with normal LVEF who are at elevated risk for cancer therapy-related cardiac dysfunction.
May support baseline GLS for risk stratification in normal-LVEF patients; hypothesis-generating and should not yet change practice.
Background: Cancer therapy-related cardiac dysfunction (CTRD) is a major source of morbidity and mortality in long-term cancer survivors. Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited.Objectives: The purpose of this study was to investigate whether baseline echocardiographic assessment of global longitudinal strain (GLS) before treatment with anthracyclines is predictive of (CTRD) in a broad cohort of patients with normal baseline LVEF.Methods: Study participants comprised 188 patients at a single institution who underwent baseline 2-dimensional (2D) speckle-tracking echocardiography before treatment with anthracyclines and at least one follow-up echocardiogram 3 months after chemotherapy initiation. Patients with a baseline LVEF <55% were excluded from the analysis. The primary endpoint, (CTRD), was defined as an absolute decline in LVEF >10% from baseline and an overall reduced LVEF <50%. Potential and known risk factors were evaluated using univariable and multivariable Cox proportional hazards regression analysis.Results: Twenty-three patients (12.23%) developed (CTRD). Among patients with (CTRD), the mean GLS was -17.51% ± 2.77%. The optimal cutoff point for (CTRD) was -18.05%. The sensitivity was 0.70 and specificity was 0.70. The area under ROC curve was 0.70. After adjustment for cardiovascular and cancer therapy related risk factors, GLS or decreased baseline GLS ≥-18% was predictive of (CTRD) (adjusted hazards ratio 1.17, 95% confidence interval 1.00, 1.36; p=0.044 for GLS, or hazards ratio 3.54; 95% confidence interval 1.34, 9.35; p = 0.011 for decreased GLS), along with history of tobacco use, pre-chemotherapy systolic blood pressure, and cumulative anthracycline dose.Conclusions: Baseline GLS or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline LVEF. This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD)
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Araujo‐Gutierrez et al. (2021) conducted a cohort in Cancer therapy-related cardiac dysfunction (CTRD) (n=188). Decreased baseline global longitudinal strain (≥ -18%) vs. Normal baseline global longitudinal strain (< -18%) was evaluated on Cancer therapy-related cardiac dysfunction (CTRD), defined as an absolute decline in LVEF >10% from baseline and an overall reduced LVEF <50% (HR 3.54, 95% CI 1.34-9.35, p=0.011). Decreased baseline global longitudinal strain (≥ -18%) was associated with a significantly increased risk of developing anthracycline-induced cardiotoxicity (HR 3.54) in cancer patients with normal baseline LVEF.
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