What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cancer (n=355). Intervention: Obesity vs. Normal BMI. Primary outcome: Suboptimal global longitudinal strain (absolute GLS ≤18.00%) (POR 2.95, 95% CI 1.24-7.03, p=0.014).

April 7, 2021Open Access

Clinical characterization, cardiovascular risk factor profile and cardiac strain analysis in a Uganda cancer population: The SATRACD study

Key Result

In Ugandan cancer patients with preserved left ventricular ejection fraction, obesity was the only independent factor associated with suboptimal global longitudinal strain (POR 2.95).

Study Design

Type

Cross-Sectional (n=355)

Multicenter

Structured PICO

Population

355 adult cancer patients in Uganda with preserved left ventricular ejection fraction planned for anthracycline therapy, assessed for cardiovascular risk factors and baseline cardiac strain.

Outcome

Prevalence of cardiovascular risk factors and baseline left ventricular global longitudinal strain (GLS)surrogate

In Ugandan cancer patients with normal LVEF prior to anthracycline therapy, suboptimal global longitudinal strain is present in 15% and is independently associated with obesity.

Main Result

Odds Ratio: 2.95 (95% CI 1.24–7.03)

Absolute Event Rate: 32.56% vs 14.68%

p-value: p=0.014

Limitations

The study population was primarily composed of certain cancer types (e.g., breast cancer), which may limit generalizability to the entire cancer population in Uganda.
Echocardiography observers were not blinded to patients' clinical status, potentially introducing bias.
Inter-observer variability for echocardiographic measurements was not assessed.

Abstract

BACKGROUND: The link between cancer and cardiovascular disease is firmly established. We sought to investigate the prevalence of cardiovascular disease (CVD) risk factors in Uganda cancer patients, their pre-chemotherapy left ventricular strain echocardiographic pattern and its associations with the CVD risk factors. METHODS AND RESULTS: Baseline pre-chemotherapy data of patients who were enrolled in the SATRACD study (a cancer cohort, who were planned for anthracycline therapy), were analyzed. The prevalence of cardiovascular risk factors and baseline strain echocardiographic images were assessed. Among the 355 patients who were recruited over a period of 15 months, 283 (79.7%) were female, with a mean age of 43 years. The types of cancer of the study patients included breast cancer (70.6%), lymphomas, sarcomas, leukemias and hepatocellular carcinoma. Hypertension was the most common comorbidity (27.0%). The prevalence of obesity was 12.1% and that of HIV was 18.3%. All patients had a normal left ventricular ejection fraction (LVEF). The mean global longitudinal strain (GLS) was -20.92 ±2.43%, with females having a significantly higher GLS than males (-21.09±2.42 vs -20.25±2.39, p = 0.008). Fifty-three patients (14.9%) had suboptimal GLS (absolute GLS≤18.00%), which was associated with obesity (POR = 3.07; 95% CI, 1.31-6.98; p = 0.003), alcohol use (POR = 1.94; 95% CI, 1.01-3.74; p = 0.044), long QTc interval in electrocardiogram (POR = 2.54; 95% CI, 1.06-5.74; p = 0.015,) and impaired left ventricular relaxation (POR = 2.24; 95% CI, 1.17-4.25; p = 0.007). On multivariable logistic regression analysis, obesity (POR = 2.95; 95% CI, 1.24-7.03; p = 0.014) was the only independent factor associated with suboptimal GLS. CONCLUSION: There is high prevalence and a unique pattern of cardiovascular risk factors in Uganda cancer patients. In cancer patients with cardiovascular risk conditions, there is reduction in GLS despite preserved LVEF. Longitudinal research is needed to study the predictive value of cardiovascular risk factors and baseline GLS for post chemotherapy cardiac dysfunction.

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