Echocardiographic systolic and diastolic function alterations in multiple myeloma patients treated with Carfilzomib

Abstract Funding Acknowledgements Type of funding sources: None. Background Carfilzomib improves the prognosis of multiple myeloma (MM) patients, but significantly increases cardiovascular toxicity. The timing and effect of carfilzomib therapy on left ventricular function is still under investigation. Purpose We sought to assess the echocardiographic systo-diastolic changes, including global longitudinal strain (GLS), in patients treated with carfilzomib and to identify predictors of increased risk of cardiovascular adverse events (CVAEs) during therapy. Methods 88 patients with MM performed a baseline cardiovascular evaluation comprehensive of transthoracic echocardiogram (TTE) before the start of Carfilzomib therapy and after about 6 months. All patients were clinically followed-up to early identify the occurrence of CVAEs for the whole therapy duration. Results After Carfilzomib treatment, mean GLS slightly decreased (-22.2% ± 2.6 vs -21.3% ± 2.5; p < 0.001). 58% of patients experienced CVAEs during therapy: 71% of them had uncontrolled hypertension, 29% had major CVAEs or CV events not related to arterial hypertension. GLS variation during therapy was not related to an increased risk of CVAEs; however, patients with baseline GLS ≥ -21% and/or left ventricular ejection fraction (LVEF) ≤ 60% had an increased risk of major CVAEs (OR = 6.2, p = 0.004; OR = 3.7, p = 0.04, respectively). Carfilzomib led to an increased risk of diastolic dysfunction (5.6% vs 13.4% p = 0.04) and to a rise in E/e’ (8.9 ± 2.7 vs 9.7 ± 3.7; p = 0.006). Conclusions Carfilzomib leads to early LV function impairment early demonstrated by GLS changes and diastolic dysfunction. Baseline echocardiographic parameters, especially GLS and LVEF, might improve cardiovascular risk stratification before treatment.

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Effects of Carfilzomib Therapy on Left Ventricular Function in Multiple Myeloma Patients

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.645678 ◽

2021 ◽

Vol 8 ◽

Author(s):

Giulia Mingrone ◽

Anna Astarita ◽

Lorenzo Airale ◽

Ilaria Maffei ◽

Marco Cesareo ◽

...

Keyword(s):

Multiple Myeloma ◽

Left Ventricular Function ◽

Diastolic Dysfunction ◽

Ventricular Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

Cardiovascular Evaluation

Background: Carfilzomib improves the prognosis of multiple myeloma (MM) patients but significantly increases cardiovascular toxicity. The timing and effect of Carfilzomib therapy on the left ventricular function is still under investigation. We sought to assess the echocardiographic systo-diastolic changes, including global longitudinal strain (GLS), in patients treated with Carfilzomib and to identify predictors of increased risk of cardiovascular adverse events (CVAEs) during therapy.Methods: Eighty-eight patients with MM performed a baseline cardiovascular evaluation comprehensive of transthoracic echocardiogram (TTE) before the start of Carfilzomib therapy and after 6 months. All patients were clinically followed up to early identify the occurrence of CVAEs during the whole therapy duration.Results: After Carfilzomib treatment, mean GLS slightly decreased (−22.2% ± 2.6 vs. −21.3% ± 2.5; p < 0.001). Fifty-eight percent of patients experienced CVAEs during therapy: 71% of them had uncontrolled hypertension, and 29% had major CVAEs or CV events not related to arterial hypertension. GLS variation during therapy was not related to an increased risk of CVAEs; however, patients with baseline GLS ≥ −21% and/or left ventricular ejection fraction (LVEF) ≤ 60% had a greater risk of major CVAEs (OR = 6.2, p = 0.004; OR = 3.7, p = 0.04, respectively). Carfilzomib led to a higher risk of diastolic dysfunction (5.6 vs. 13.4%, p = 0.04) and to a rise in E/e′ ratio (8.9 ± 2.7 vs. 9.7 ± 3.7; p = 0.006).Conclusion: Carfilzomib leads to early LV function impairment early demonstrated by GLS changes and diastolic dysfunction. Baseline echocardiographic parameters, especially GLS and LVEF, might improve cardiovascular risk stratification before treatment.

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Abstract 16422: Lower Mitochondrial-derived Peptide Humanin in Young Adults Born Preterm vs. Term and Association With Left Ventricular Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.16422 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Daniela Ravizzoni Dartora ◽

Adrien Flahualt ◽

Carolina Nobre Pontes ◽

Gabriel Altit ◽

Alyson Deprez ◽

...

Keyword(s):

Young Adults ◽

Ejection Fraction ◽

Experimental Models ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Mitochondrial Alterations ◽

Increased Risk

Introduction: Preterm (PT) birth is associated with increased risk of cardiovascular diseases (CVD) and heart failure. We previously reported left ventricular (LV) mitochondrial dysfunction in a rat model mimicking the deleterious conditions associated with PT birth. Whether mitochondrial function is altered in humans born PT and associated with LV function changes is unknown. We aimed to determine if serum humanin levels, a mitochondrial-derived peptide with cytoprotective effects, are altered in humans born PT and are associated with impaired myocardial function. Methods: Data were obtained from 55 young adults born PT (<30 weeks of gestational age, GA) compared to 54 full-term (T) controls of the same age. Serum humanin levels were determined by ELISA and LV ejection fraction (LVEF) by echocardiography. Results are shown as median (interquartile range) and comparisons between groups were performed using non-parametric tests. Results: Individuals were evaluated at 23.3 (21.4, 25.3) years, and age and sex distribution were similar between groups. Median GA was 27.5 (26.2, 28.4) weeks in the PT group. Humanin levels (pg/ml) were 132.9 (105.1, 189.3) and 161.1 (123.6, 252) in the PT and the T groups, respectively (p=0.0414). LVEF was within the normal range and similar between groups. Lower LVEF was associated with lower humanin levels (p<0.001), and this association was observed both in the term (p=0.002) and the preterm (p=0.047) groups. Conclusions: Serum humanin levels are lower in adult born PT. Since lower humanin levels are also associated with lower LVEF, our results suggest that mitochondrial alterations could play a role in the long-term adverse cardiovascular consequences of PT birth. Humanin analogs improve LV function in experimental models. Our results pave the way for future studies exploring humanin as a therapeutic avenue for the prevention and treatment of CVD in individuals born PT.

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P818 Association between baseline left ventricular longitudinal strain and follow-up left ventricular ejection fraction in patients with dilated cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.470 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I H Jung ◽

Y S Byun ◽

J H Park

Keyword(s):

Ejection Fraction ◽

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Lv Function ◽

Ventricular Ejection Fraction

Abstract Funding Acknowledgements no Background Left ventricular global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LV reverse remodeling (LVRR) in DCM patients with sinus rhythm and also investigate the relationship between baseline LV GLS and follow-up LVEF. Methods We enrolled patients with DCM who had been initially diagnosed, evaluated, and followed at our institute. Results During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45) within 14.7 ± 10.0 months of medical therapy. The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9% and was not different from the value of 27.1 ± 7.4% (p = 0.49) of those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS and follow-up LVEF (r = 0.717; p <0.001). Conclusion There was a significant correlation between baseline LV GLS and follow-up LVEF in this population. Baseline Follow-up Difference (95% CI) p-value All patients (n = 160) LVEDDI, mm/m2 35.6 ± 6.6 35.6 ± 6.6 -2.7 (-3.4 to -2.0) <0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) <0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) <0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) <0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) <0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) <0.001 Patients without LVRR (n = 115) LVEDDI, mm/m2 34.9 ± 6.8 34.1 ± 6.8 -0.8 (-1.3 to -0.3) 0.002 LVESDI, mm/m2 29.5 ± 6.1 28.4 ± 6.4 -1.4 (-1.8 to -0.4) 0.002 LVEDVI, mL/m2 92.0 ± 30.5 83.4 ± 29.8 -8.6 (-12.4 to -4.8) <0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) <0.001 LVEF, % 27.1 ± 7.4 27.8 ± 7.4 0.7 (-0.2 to 1.6) 0.126 LV GLS (-%) 8.2 ± 2.9 8.7 ± 3.2 0.5 (0.7 to 3.6) <0.001 Patients with LVRR (n = 45) LVEDDI, mm/m2 37.4 ± 5.5 29.8 ± 5.2 -7.5 (-9.1 to -6.0) <0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) <0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) <0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) <0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) <0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) <0.001 Baseline and Follow-up LV Functional Echocardiographic Data Abstract P818 Figure.

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Diastolic dysfunction and mortality in 436 360 men and women: the National Echo Database Australia (NEDA)

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa253 ◽

2020 ◽

Cited By ~ 2

Author(s):

David Playford ◽

Geoff Strange ◽

David S Celermajer ◽

Geoffrey Evans ◽

Gregory M Scalia ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Diastolic Function ◽

Cardiovascular Imaging ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Prognostic Impact ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

American Society ◽

Related Mortality

Abstract Aims To examine the characteristics/prognostic impact of diastolic dysfunction (DD) according to 2016 American Society of Echocardiography (ASE) and European Society of Cardiovascular Imaging (ESCVI) guidelines, and individual parameters of DD. Methods and results Data were derived from a large multicentre mortality-linked echocardiographic registry comprising 436 360 adults with ≥1 diastolic function measurement linked to 100 597 deaths during 2.2 million person-years follow-up. ASE/European Association of Cardiovascular Imaging (EACVI) algorithms could be applied in 392 009 (89.8%) cases; comprising 11.4% of cases with ‘reduced’ left ventricular ejection fraction (LVEF < 50%) and 88.6% with ‘preserved’ LVEF (≥50%). Diastolic function was indeterminate in 21.5% and 62.2% of ‘preserved’ and ‘reduced’ LVEF cases, respectively. Among preserved LVEF cases, the risk of adjusted 5-year cardiovascular-related mortality was elevated in both DD [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.22–1.42; P < 0.001] and indeterminate status cases (OR 1.11, 95% CI 1.04–1.18; P < 0.001) vs. no DD. Among impaired LVEF cases, the equivalent risk of cardiovascular-related mortality was 1.51 (95% CI 1.15–1.98, P < 0.001) for increased filling pressure vs. 1.25 (95% CI 0.96–1.64, P = 0.06) for indeterminate status. Mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi all correlated with mortality. On adjusted basis, pivot-points of increased risk for cardiovascular-related mortality occurred at 90 cm/s for E wave velocity, 9 cm/s for septal e’ velocity, an E:e’ ratio of 9, and an LAVi of 32 mL/m2. Conclusion ASE/EACVI-classified DD is correlated with increased mortality. However, many cases remain ‘indeterminate’. Importantly, when analysed individually, mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi revealed clear pivot-points of increased risk of cardiovascular-related mortality.

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Echocardiographic Evaluation of LV Function in Patients with Tachyarrhythmia and Reduced Left Ventricular Function in Response to Rhythm Restoration

Journal of Clinical Medicine ◽

10.3390/jcm10163706 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3706

Author(s):

Christian Schach ◽

Thomas Körtl ◽

Rolf Wachter ◽

Lars S. Maier ◽

Samuel Sossalla

Keyword(s):

Heart Rate ◽

Ejection Fraction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Ventricular Geometry ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Systolic Volume

Aims: Tachyarrhythmia due to atrial fibrillation (AF) is often associated with reduced left ventricular (LV) function and has been proposed to cause arrhythmia-induced cardiomyopathy (AIC). However, the precise diagnostics of AIC and reversibility after rhythm restoration are poorly understood. Our aim was to investigate systolic LV function in tachycardic AF and to evaluate the direct effect of rhythm restoration. Methods: We prospectively studied 24 patients (71% male, age 65 ± 9 years) with tachycardic AF and newly diagnosed reduced left ventricular ejection fraction (LVEF). Just before and immediately after electrical cardioversion (ECV), transthoracic echocardiography was performed. Geometric as well as functional data were assessed. Results: Patients presented with a heart rate (HR) of 117.4 ± 21.6/min and a 2D-/3D-LVEF of 32 ± 9/31 ± 8%. ECV to sinus rhythm normalized HR to 77 ± 11/min with an increase of 2D-/3D-LVEF to 37 ± 9/37 ± 10% (p < 0.01 vs. baseline, each). Left ventricular geometry changed with an increase of end-diastolic volume (LVEDV) while end-systolic volume (LVESV) remained unchanged. Parameters concerning myocardial deformation (global longitudinal strain (GLS), strain rate (SR)) decreased whereas the RR interval-corrected GLS (GLSc) remained unchanged. In a simple linear regression model, GLS correlated with 2D- and 3D-LVEF not only before (pre) ECV, but also after (post) ECV. We demonstrate that the increase of LVEF and GLS (ratios pre/post) correlates with the change of HR (ΔHR; R2 = 0.20, 0.33 and 0.32, p < 0.05 each), whereas ratios of GLSc and SR do not significantly correlate with HR (R2 = 0.03 and 0.01, p = n.s. each). Conclusion: In patients with tachyarrhythmia and reduced ejection fraction, ECV leads to immediate improvement in EF and GLS while HR-corrected LV contractility remains unchanged. This suggests that the immediate effects of rhythm restoration are mostly related to changes in left ventricular volume, but not to an acute improvement of heart-rate independent contractility.

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Abstract 15455: Prevalence of Subclinical Myocardial Dysfunction in Hospitalized Patients With Covid-19 and Association With In-hospital Mortality

Circulation ◽

10.1161/circ.142.suppl_3.15455 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anum Minhas ◽

Nisha A Gilotra ◽

Erin Goerlich ◽

Brian T Garibaldi ◽

Thomas S Metkus ◽

...

Keyword(s):

Hospital Mortality ◽

Myocardial Function ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Cardiac Injury ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Artery Disease

Introduction: Acute cardiac injury has been reported in COVID-19. However, the extent of subclinical myocardial dysfunction on imaging has not been characterized. We determined the prevalence of myocardial dysfunction using speckle tracking echocardiography (STE) in hospitalized COVID-19 patients and its association with cardiovascular risk factors and mortality. Methods: We retrospectively studied hospitalized COVID-19 patients undergoing echocardiography with STE (n=83). We investigated the association of global longitudinal strain (GLS) and myocardial work efficiency (MWE), a load independent measure of myocardial function, with clinical parameters. Logistic regression was used to examine associations of GLS and MWE with in-hospital mortality. Abnormal left ventricular ejection fraction (LVEF) was defined as <50%. Abnormal GLS and MWE were defined as >-18% and <95%, respectively. Results: Mean age was 66±14 years and 59% were men. There were 16/83 (19%) with reduced LVEF (<50%), while 64% (53/83) had abnormal GLS (>-18%) and 79% (59/75) had abnormal MWE (<95%) ( Figure ). Patients with abnormal GLS had higher body mass index (BMI) (32±8 vs 28±5 kg/m 2 , p=0.016) and more frequent diabetes (47 vs 23%, p=0.03) and patients with abnormal MWE had more frequent diabetes (49 vs 6%, p=0.002), compared to normal. Higher MWE was associated with lower mortality unadjusted (OR 0.92 [95% CI 0.85-0.99]; p=0.048) and after adjusting for age, sex, diabetes, hypertension, and coronary artery disease (OR 0.87 [95% CI 0.78-0.97]; p=0.014). This remained true on sensitivity analysis of only those with normal LVEF, adjusting for age and sex (n=61). GLS and LVEF were not associated with mortality. Conclusions: Abnormal myocardial function is prevalent in hospitalized COVID-19 patients undergoing STE. Higher MWE was associated with lower in-hospital mortality. Larger studies are warranted to determine the prognostic role of sensitive markers of LV function in COVID-19.

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Serum biomarkers for detection of cardiomyopathy in survivors of childhood cancer: A report from the St. Jude Lifetime Cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e21526 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e21526-e21526

Author(s):

Stephanie Dixon ◽

Carrie R. Howell ◽

Lu Lu ◽

Kirsten K. Ness ◽

Juan Plana ◽

...

Keyword(s):

Childhood Cancer ◽

Troponin T ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

New Onset

e21526 Background: Childhood cancer survivors are at increased risk for cardiovascular morbidity and mortality. Little is known about the utility of cardiac biomarkers (NT-proBNP, cardiac troponin-T [TnT]) for long-term surveillance. Methods: Cross-sectional analyses of 1213 survivors ≥18 years of age and ≥10 years from cancer diagnosis (786 exposed to cardiotoxic therapy [174 radiation therapy (RT) alone, 366 anthracycline alone, 246 both] and 427 unexposed). TnT > 0.01 ng/ml and NT-proBNP levels > 97.5th percentile age- and sex-specific cutoffs were considered abnormal. Three-dimensional left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic function and cardiomyopathy (CM) according to the CTCAE v4.03 were evaluated. Generalized linear models estimated risk ratios (RR) and 95% confidence intervals (CI). Results: Among survivors (median 8.7 [range 0.0-23.6] years at diagnosis; 35.5 [range 19.1-62.2] years at evaluation), NT-proBNP and TnT were abnormal in 22.5% and 0.4%, respectively. A dose-dependent increased risk for abnormal NT-proBNP was seen with exposure to chest RT (referent no RT, 1- < 20 Gy RR 1.62 [CI 1.07-2.46], 20- < 30 Gy RR 1.68 [1.23-2.30], ≥30 Gy RR 3.66 [2.89-4.64]; p for trend < 0.0001) and anthracycline (referent no anthracycline, 1-200mg/m2 RR 1.39 [1.01-1.91], 201-350mg/m2 RR 2.28 [1.74-2.99], > 350mg/m2 RR 2.99 [2.27-3.95]; p for trend < 0.0001). Survivors with CM at the time of evaluation had abnormal NT-proBNP (grade 2 CM RR 1.46, CI 1.08-1.99; grade 3-4 CM 2.66, 2.02-2.39). However, among exposed survivors previously undiagnosed with clinical CM, NT-proBNP had poor sensitivity and moderate specificity in identifying those with new onset of abnormal LVEF ( < 53%), GLS or diastolic dysfunction: sensitivity (29%, 30%, 33%), specificity (75%, 77%, 76%). Also, 132 (20.2%) had abnormal NT-proBNP with normal LVEF (≥53%). Conclusions: Abnormal NT-proBNP levels were prevalent and associated with prior cardiotoxic therapy and established CM but were not sensitive for detection of new onset CM. Longitudinal follow-up is needed to determine whether abnormal NT-proBNP in the large number of survivors without CM is predictive of future CM.

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P1575Cardiovascular toxicity following modern multiple myeloma therapy in Japanese cohort

European Heart Journal ◽

10.1093/eurheartj/ehz748.0335 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Shibata ◽

S Nohara ◽

K Nagafuji ◽

Y Fukumoto

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Multiple Myeloma ◽

Troponin I ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Prior History ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

History Of

Abstract Background Multiple myeloma (MM) is a plasma cell dyscrasia accounting for approximately 13% of hematologic malignancies. Patients with MM have an increased risk of cardiovascular adverse events (CAEs) due to disease burden and/or anti-myeloma treatment-related risk factors. However, little is known about the incidence of cardiovascular toxicity of patients with MM. Methods We analyzed 42 consecutive patients (Male/Female 22/20, age 67±10 years old) who received anti-MM therapies between October 2016 and September 2018 from our University Cardio-REnal Oncology (CREO) registry. We examined the incidence of CAEs through January 2019 including congestive heart failure and cardiomyopathy (CHF/CM), ischemic cardiac event, newly symptomatic arrhythmias included atrial fibrillation or flutter requiring treatment, and venous thromboembolism (VTE). Results Within the 408-day median follow-up period (range 15–844 days), CAEs occurred in 23.8% (n=10); CHF/CM in 11.9%, newly diagnosed atrial fibrillation in 4.8%, VTE in 4.8%, vasospastic angina in 2.4%, and death in 28.6%. There were no significant differences between CAEs group and non-CAEs group in terms of sex, body mass index (BMI), incidence of hypertension, ischemic heart disease, prior history of heart failure, cardiovascular medications, left ventricular ejection fraction, serum high-sensitivity troponin-I, estimated glomerular filtration rate, blood urea nitrogen and N-terminal pro-brain natriuretic peptide levels at the time of enrollment. The use of various types of proteasome inhibitors and immunomodulatory drugs were not associated with the increased risk of CAEs. By multivariate analysis, a history of prior anti-myeloma therapies was identified as an independent risk factor for CAEs. Conclusion CAEs were significantly associated with the recurrent MM in Japanese MM patients.

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432 Traditional markers of myocardial dysfunction fail to detect marked reductions in physical capacity amoung chemotherapy patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.245 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Howden ◽

S Foulkes ◽

L Wright ◽

K Janssens ◽

H Dillon ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Function ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Lv Function ◽

Cell Transplant ◽

Ventricular Ejection Fraction ◽

Increased Risk

Abstract Left ventricular ejection fraction (LVEF) is the current standard of care for evaluating chemotherapy-associated cardiotoxicity but changes in LVEF are poorly associated with outcomes and long-term heart failure risk. We sought to compare a more global measure of integrative cardiovascular function (VO2peak) that is strongly associated heart failure and early mortality risk with LVEF, global longitudinal strain (GLS) and cardiac biomarkers. Methods 95 patients who were due to commence anti-cancer treatment (n = 58 anthracycline chemotherapy for breast cancer; n = 25 Bruton’s tyrosine kinase inhibitor and n = 12 allogeneic stem cell transplant for haematological cancers) completed a pre-treatment and follow-up assessment within 6 months of initiating treatment. Changes in echocardiographic measures of LV function (LVEF, GLS), cardiac biomarkers (troponin and BNP) and cardiopulmonary exercise test (CPET, VO2peak) were measured. Results Of 95 participants who underwent baseline testing, follow-up CPET and echocardiography data was available in 89 participants. LV function was normal prior to treatment (LVEF 61.5 ± 5.9%; GLS -19.4 ± 2.3) but VO2peak (23.4 ± 6.5ml/kg/min) was only 83 ± 21% (range 47-146%) of age-predicted. After treatment, we observed marked reductions in fitness (Δ-2.1 ± 3.7 ml/kg/min or -9 ± 15%, P < 0.001) which was associated with small non-clinically significant changes in LV function (LVEF Δ-2.4 ± 6.4% P = 0.001; GLS Δ-0.5 ± 1.9 P = 0.018). Troponin was increased significantly (4.0 ± 5.5 to 23.5 ± 22.5ng/ml, P < 0.001), with no change in BNP (37.5 ± 31.4 to 32.7 ± 22.0pg/ml, P = 0.87). Current diagnostic criteria for cardiac toxicity were not met in any patient despite some patients developing disabling reductions in functional capacity (VO2peak < 16ml/min/kg). Conclusion Despite normal resting LV function prior to commencing treatment VO2peak was below age predicted. Treatment further impaired exercise cardiovascular function with minimal impact on resting measures of LV function. The assessment of cardiovascular function using CPET prior to, and following chemotherapy may be a more sensitive means of identifying patients at increased risk of future heart failure.

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The Predictive Value of 2D Myocardial Strain for Epirubicin-Induced Cardiotoxicity

Journal of Oncology ◽

10.1155/2020/5706561 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Ichrak Ben Abdallah ◽

Sonia Ben Nasr ◽

Chadia Chourabi ◽

Marouane Boukhris ◽

Israa Ben Abdallah ◽

...

Keyword(s):

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Infusion Chemotherapy ◽

Thoracic Irradiation ◽

Increased Risk ◽

A Prospective Study

Introduction. Although epirubicin has significantly improved outcome in breast cancer (BC) patients, it is responsible for myocardial dysfunction that affects patients’ quality of life. The use of 2D global longitudinal strain (GLS) has been reported to detect early myocardial dysfunction. The aim of this study was to evaluate how GLS changes can predict cardiotoxicity. Methods. We conducted a prospective study from March 2018 to March 2020 on 66 patients with no cardiovascular risk factors, who presented with BC and received epirubicin. We measured left ventricular ejection fraction (LVEF) and GLS before chemotherapy, at three months (T3), and at 12 months (T12) from the last epirubicin infusion. Chemotherapy-Related-Cardiac-Dysfunction (CTRCD) was defined as a decrease of 10% in LVEF to a value below 53% according to ASE and EACI 2014 expert consensus. Results. The mean age at diagnosis was 47 ± 9 years old. At baseline, median LVEF was 70% and median GLS was −21%. Shortly after chemotherapy completion, two patients presented with symptomatic heart failure while asymptomatic CTRCD was revealed in three other patients at T12. Three months after the last epirubicin infusion, median LVEF was 65%, median GLS was −19%, and median GLS variation was 5%. However, in patients who presented with subsequent CTRCD, median GLS at T3 was −16% and median GLS variation was 19% ( p = 0.002 and p < 0.001 , respectively, when compared to patients who did not develop cardiotoxicity). Persistent GLS decrease at T3 was an independent predictor of CTRCD at T12. Age and left-sided thoracic irradiation did not increase the risk of cardiotoxicity in our study while the cumulative dose of epirubicin significantly affected cardiologic findings ( p = 0.001 ). Conclusion. This was the first North African study that assesses the value of measuring GLS to early detect cardiotoxicity. Patients whose GLS remained decreased after 3 months from anthracyclines-base chemotherapy had an increased risk for developing subsequent CTRCD. Further studies with larger sample size are warranted to identify the best cardioprotective molecules to be initiated in these patients before LVEF declines.

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