Key result
A ≥15% drop in GLS is linked to ~7.4-fold higher odds of early ICI cardiotoxicity.
Why the study?
Immune checkpoint inhibitors may cause immune-mediated cardiotoxicity, and because LVEF typically declines late, more sensitive markers like global longitudinal strain are needed for early detection of subclinical myocardial injury.
Does serial global longitudinal strain (GLS) monitoring predict early cardiotoxicity in adult cancer patients receiving immune checkpoint inhibitor therapy?
Cohort (n=30)
Echocardiographic analyses performed by two cardiologists blinded to clinical outcomes
No
Does serial global longitudinal strain (GLS) monitoring predict early cardiotoxicity in adult cancer patients receiving immune checkpoint inhibitor therapy?
Early deterioration in global longitudinal strain (≥ 15% relative reduction) precedes LVEF decline and shows exploratory discriminatory ability for detecting early cardiotoxicity in patients receiving immune checkpoint inhibitors.
Answers are grounded in this paper and cite their sources.
≥15% GLS reduction may flag early ICI cardiotoxicity; leaves open utility pending larger prospective validation.
Background Immune checkpoint inhibitors (ICIs) improve survival in various malignancies but may cause immune-mediated cardiotoxicity. Because left ventricular ejection fraction (LVEF) typically declines late, more sensitive markers are needed for early detection of subclinical myocardial injury. This study investigated the association between changes in global longitudinal strain (GLS) and early cardiotoxicity in patients receiving ICIs. Methods In this prospective, single-center pilot study, 30 consecutive adult patients scheduled for ICI therapy were enrolled. Serial transthoracic echocardiography was performed at baseline, 6 to 8 weeks, and 12 weeks to measure LVEF using the biplane Simpson method and GLS using 2D speckle-tracking echocardiography. Cardiotoxicity was defined as a ≥ 10% absolute reduction in LVEF to < 50% and/or new-onset heart failure, suspected myocarditis, clinically significant arrhythmia, or major cardiovascular events. A relative GLS reduction ≥ 15% was considered indicative of subclinical dysfunction. Results During a mean 12-week follow-up, cardiotoxicity occurred in six patients (20.0%). In affected patients, GLS significantly deteriorated early (from − 18.2% ± 2.5% to − 14.1% ± 2.8%, P < 0.001), preceding any significant decline in LVEF. Patients without cardiotoxicity showed stable GLS and LVEF values. A ≥ 15% GLS reduction was associated with cardiotoxicity and showed exploratory discriminatory ability, with 83.3% sensitivity and 91.7% specificity (area under the curve, 0.86; 95% confidence interval, 0.72–0.97). Conclusions Early GLS deterioration was associated with cardiotoxicity despite relatively preserved LVEF. Given the temporal overlap between GLS assessment and cardiotoxicity events in several patients, these findings should be considered exploratory and hypothesis-generating.
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Korucu et al. (2026) conducted a cohort in Malignancy scheduled for immune checkpoint inhibitor (ICI) therapy (n=30). Relative global longitudinal strain (GLS) reduction ≥15% on 2D speckle-tracking echocardiography during immune checkpoint inhibitor therapy vs. Patients without cardiotoxicity / <15% relative GLS reduction was evaluated on Development of cardiotoxicity (≥10% absolute decline in LVEF to <50% and/or new symptomatic heart failure, suspected myocarditis, significant ventricular arrhythmia, or major cardiovascular events) over 12 weeks (OR 7.4, p=0.02). A ≥15% relative reduction in global longitudinal strain predicted early ICI-associated cardiotoxicity with an AUC of 0.86 (95% CI 0.72–0.97) and adjusted OR ≈ 7.4 (p=0.02).
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