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The association of reduced global longitudinal strain with cancer therapy-related cardiac dysfunction among patients receiving cancer therapy

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Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Cardiotoxicity is a leading cause of morbidity and mortality among patients receiving cancer therapy. The most commonly used definition is cancer therapy-related cardiac dysfunction (CTRCD) defined by a left ventricular ejection fraction reduction. Global longitudinal strain (GLS) has been implied to be superior in detecting early subclinical dysfunction.

Objectives

Evaluate the prevalence of reduced GLS and whether it is associated with CTRCD development among patients receiving cancer therapy.

Methods

Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients receiving different types of cancer therapy, who were referred to the cardio-oncology clinic. Patients were divided into two groups—reduced GLS (> − 17%) vs. preserved GLS (≤ − 17%). Multivariable analyses were adjusted for a propensity score for baseline characteristics.

Results

Among 291 consecutive patients, 48 (16%) patients were included in the reduced GLS group. Overall, 11 (5%) patients developed CTRCD at following echocardiogram evaluation. Patients with preserved GLS had a significantly lower risk for CTRCD development [odds ratio (OR) 0.11, 95% confidence interval (CI) 0.03–0.41, p = 0.001], with every 1-unit improvement of GLS the risk of CTRCD decreased by 16% (OR 0.84, 95%CI 0.73–0.95, p = 0.007). After adjustment for baseline characteristics, including cardiovascular risk factors and systolic function, preserved GLS remained significantly associated with a lower risk for CTRCD development (OR 0.11, 95%CI 0.02–0.64, p = 0.014), with every 1-unit improvement lowering the risk by 19% (OR 0.81, 95%CI 0.67–0.98, p = 0.032).

Conclusions

Reduced GLS is common among patients receiving cancer therapy and may identify patients at increased risk for CTRCD development.

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Abbreviations

CTRCD:

Cancer therapy-related cardiac dysfunction

LVEF:

Left ventricular ejection fraction

GLS:

Global longitudinal strain

STE:

Speckle-tracking echocardiography

ANT:

Anthracyclines

LV:

Left ventricle

SD:

Standard deviation

IQR:

Interquartile ranges

BB:

Beta blocker

ACEI:

Angiotensin converting enzyme inhibitor

ARB:

Angiotensin II receptor blocker

LVEDD:

Left ventricle end diastolic diameter

LVESD:

Left ventricle end systolic diameter

OR:

Odd ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel

    Michal Laufer-Perl, Joshua H. Arnold, Liat Mor, Matthew Derakhshesh, Yonatan Moshkovits, Ben Sadeh, Yaron Arbel, Yan Topilsky & Zach Rozenbaum

  2. Internal Medicine D, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nadav Amrami

Authors
  1. Michal Laufer-Perl
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  2. Joshua H. Arnold
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  3. Liat Mor
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  4. Nadav Amrami
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  5. Matthew Derakhshesh
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  6. Yonatan Moshkovits
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  7. Ben Sadeh
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  8. Yaron Arbel
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  9. Yan Topilsky
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  10. Zach Rozenbaum
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Correspondence to Michal Laufer-Perl.

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Laufer-Perl, M., Arnold, J.H., Mor, L. et al. The association of reduced global longitudinal strain with cancer therapy-related cardiac dysfunction among patients receiving cancer therapy. Clin Res Cardiol 109, 255–262 (2020). https://doi.org/10.1007/s00392-019-01508-9

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  • DOI: https://doi.org/10.1007/s00392-019-01508-9

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