Diagnostic and Prognostic Value of Myocardial Work Indices for Identification of Cancer Therapy–Related Cardiotoxicity

Calvillo‐Argüelles, Oscar; Thampinathan, Babitha; Somerset, Emily; Shalmon, Tamar; Amir, Eitan; Fan, Chun‐Po Steve; Moon, Sangkyu; Abdel‐Qadir, Husam; Thevakumaran, Yobiga; Day, Jennifer; Woo, Anna; Wintersperger, Bernd J.; Marwick, Thomas H.; Thavendiranathan, Paaladinesh

doi:10.1016/j.jcmg.2022.02.027

Cited by 41 publications

(26 citation statements)

References 27 publications

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“…Moreover, we demonstrated that MWI, MWE and CW (and not WW and GLS) were able to predict moderate CTRCD. This in line with previous observations that showed a lower MWE at baseline in patients who developed CTRCD during follow-up [ 27 ]. As MWE is related to variations in both CW and WW with CW reflecting the Myocardial Work that contributes to cardiac output and WW the work that does not contribute to it, changes in each of these parameters could account for this observation.…”

Section: Discussionsupporting

confidence: 93%

“…In contrast to the work of Calvillo-Argüelles et al, we demonstrated that not a higher WW but rather lower CW was responsible for the depressed MWE at baseline in patients with moderated CTRCD during follow-up. This may suggest there exists a distinct phenotype with a higher susceptibility for developing CTRCD, characterized by an inherent less efficient LV performance due to lower contractile capacity [ 27 ]. Therefore, MW features such as low baseline CW, especially when associated with a rise in WW during follow-up, may identify patients at risk for CTRCD.…”

Section: Discussionmentioning

confidence: 99%

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Serial Non-Invasive Myocardial Work Measurements for Patient Risk Stratification and Early Detection of Cancer Therapeutics-Related Cardiac Dysfunction in Breast Cancer Patients: A Single-Centre Observational Study

Moyá

Buytaert

Beles

et al. 2023

JCM

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Serial transthoracic echocardiographic (TTE) assessment of LVEF and GLS are the gold standard in screening Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD). Non-invasive left-ventricle (LV) pressure–strain loop (PSL) emerged as a novel method to quantify Myocardial Work (MW). This study aims to describe the temporal changes and longitudinal trajectories of MW indices during cardiotoxic treatment. We included 50 breast cancer patients with normal LV function referred for anthracycline therapy w/wo Trastuzumab. Medical therapy, clinical and echocardiographic data were recorded before and 3, 6, and 12 months after initiation of the chemotherapy. MW indices were calculated through PSL analysis. According to ESC guidelines, mild and moderated CTRCD was detected in 10 and 9 patients, respectively (20% CTRCDmild, 18% CTRCDmod), while 31 patients remained free of CTRCD (62% CTRCDneg). Prior to chemotherapy MWI, MWE and CW were significantly lower in CTRCDmod than in CTRCDneg and CTRCDmild. Overt cardiac dysfunction in CTRCDmod at 6 months was accompanied by significant worse values in MWI, MWE and WW compared to CTRCDneg and CTRCDmild. MW features such as low baseline CW, especially when associated with a rise in WW at follow-up, may identify patients at risk for CTRCD. Additional studies are needed to explore the role of MW in CRTCD.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Serial Non-Invasive Myocardial Work Measurements for Patient Risk Stratification and Early Detection of Cancer Therapeutics-Related Cardiac Dysfunction in Breast Cancer Patients: A Single-Centre Observational Study

Moyá

Buytaert

Beles

et al. 2023

JCM

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“…The most notable finding of the study was that GWI and GWE were decreased after the sixth cycle, whereas GLS showed a significant change after the fourth cycle, indicating that GLS is still a sensitive indicator of cardiac dysfunction. Calvillo-Argüelles et al 68 studied 136 HER2+ breast cancer patients receiving anthracycline and trastuzumab therapy, concluding that myocardial work indices did not offer any measurable improvement over GLS and clinical risk factors in predicting CTRCD identified at subsequent visits. They did find that in a small subset of patients with a GLS change (<3.3%) and a systolic blood pressure reduction (>21 mm Hg), myocardial work indices were associated with a higher probability of concurrent CTRCD than GLS.…”

Section: Myocardial Workmentioning

confidence: 98%

“…63 Cardio-oncology Myocardial work indices associated with a higher probability of concurrent CTRCD than GLS in small subset of patients with >21 mm Hg systolic blood pressure reduction and a GLS change (<3.3%). 68 Valvular heart disease GWI, GCW, and GWW increased in aortic stenosis patients. Reduced GWI and GCW at follow-up are associated with increased mortality.…”

Section: Aortic Regurgitationmentioning

confidence: 99%

Myocardial Work in Echocardiography

Marzlin

Hays²,

Peters

et al. 2023

Circ: Cardiovascular Imaging

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Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.

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“…More specifically global work index and global work efficiency had a more pronounced variation in patients with treatment-induced cardiac dysfunction. 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer

Zekri

Rasool

Rizvi

et al. 2023

Womens Health (Lond Engl)

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Background: Chemotherapy regimens containing a combination of anti-Her2 antibodies are effective but can be associated with cardiac toxicity. Objectives: We evaluate the outcome with a particular focus on the cardiac function of patients with Her2 over-expressed breast cancer receiving Chemotherapy regimens combined with Trastuzumab and Pertuzumab in routine clinical practice settings. Design and methods: The initial cohort of patients who started Chemotherapy regimens in combination with Trastuzumab and Pertuzumab before September 2019 in four cancer units were reviewed retrospectively. All patients had regular measurements of left ventricular ejection fraction by Doppler ultrasound. Results: Sixty-seven patients were identified. Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment were administered in the neoadjuvant and palliative settings in 28 (41.8%) and 39 (58.2%) patients, respectively. All patients underwent left ventricular ejection fraction assessment prior to starting Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment and at 3 and 6 months later. Subsequently, left ventricular ejection fraction was measured at 9, 12, 15, 18, 21, and 24 months as long as patients are still receiving any of the treatment components. Compared to baseline, the mean left ventricular ejection fraction was not significantly different at any of the subsequent time points (range; decrease by 0.936% to increase by 1.087%: T-test P value not statistically significant for all comparisons). Trastuzumab and Pertuzumab administration was withheld temporarily for two patients due to clinically suspected cardiac toxicity which was excluded upon further investigations. In the neoadjuvant cohort, 82.3% of patients were relapse free at 3 years. The median progression-free survival was 20 months, and the median overall survival was 41 months in the palliative cohort. Conclusion: In this cohort describing our limited initial experience, dual anti-Her2 antibodies (Trastuzumab and Pertuzumab) combined with chemotherapy is effective and not associated with significant cardiac toxicity when the left ventricular ejection fraction is measured every 3 months. This may suggest that previous concerns about cardiotoxicity may have been overemphasized. Further studies investigating less frequent left ventricular ejection fraction monitoring may be warranted.

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Diagnostic and Prognostic Value of Myocardial Work Indices for Identification of Cancer Therapy–Related Cardiotoxicity

Cited by 41 publications

References 27 publications

Serial Non-Invasive Myocardial Work Measurements for Patient Risk Stratification and Early Detection of Cancer Therapeutics-Related Cardiac Dysfunction in Breast Cancer Patients: A Single-Centre Observational Study

Serial Non-Invasive Myocardial Work Measurements for Patient Risk Stratification and Early Detection of Cancer Therapeutics-Related Cardiac Dysfunction in Breast Cancer Patients: A Single-Centre Observational Study

Myocardial Work in Echocardiography

Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer

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