Myocardial Strain Is Associated with Adverse Clinical Cardiac Events in Patients Treated with Anthracyclines

Ali, Mohammed T.; Yucel, Evin; Bouras, Souhila; Wang, Lin; Fei, Hongwen; Halpern, Elkan F.; Scherrer‐Crosbie, Marielle

doi:10.1016/j.echo.2016.02.018

Cited by 89 publications

(76 citation statements)

References 31 publications

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“…Our finding that the predictive power of GLS is better than that of EF may be related to its superior accuracy and reproducibility, when measured by both 2DE (6–8) and 3DE (17,18). A possible reason for the improved reproducibility and accuracy compared with EF may be related to the methodology of the semiautomated speckle tracking algorithm.…”

Section: Discussionmentioning

confidence: 77%

“…Newer techniques for quantitative evaluation of LV function include speckle tracking echocardiography (STE), which allows measurements of myocardial deformation parameters, such as global longitudinal strain (GLS). The strengths of GLS include better reproducibility and ability to detect subtle changes in myocardial function that precede changes in EF, as reported in a variety of disease states (6–8). Studies have shown that GLS can also predict mortality, potentially more accurately than EF (9–15).…”

mentioning

confidence: 99%

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2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape

Medvedofsky

Maffessanti

Weinert

et al. 2018

JACC: Cardiovascular Imaging

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OBJECTIVES This study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional echocardiographic (2DE) measurements, and that 3DE-based LV shape analysis may have added prognostic value. BACKGROUND Previous studies have shown that both LVEF and GLS derived from 2DE images predict mortality. Recently, 3DE measurements of these parameters were found to be more accurate and reproducible because of independence of imaging plane and geometric assumptions. Also, 3DE analysis offers an opportunity to accurately quantify LV shape. METHODS We retrospectively studied 416 inpatients (60 18 years of age) referred for transthoracic echocardiography between 2006 and 2010, in whom good-quality 2DE and 3DE images were available. Mortality data through 2016 were collected. Both 2DE and 3DE images were analyzed to measure LVEF and GLS. Additionally, 3DE-derived LV endocardial surface information was analyzed to obtain global shape indices (sphericity and conicity) and regional curvature (anterior, septal, inferior, lateral walls). Cardiovascular (CV) mortality risks related to these indices were determined using Cox regression. RESULTS Of the 416 patients, 208 (50%) died, including 114 (27%) CV-related deaths over a mean follow-up period of 5 3 years. Cox regression revealed that age and body surface area, all 4 LV function indices (2D EF, 3D EF, 2D GLS, 3D GLS), and regional shape indices (septal and inferior wall curvatures) were independently associated with increased risk of CV mortality. GLS was the strongest prognosticator of CV mortality, superior to EF for both 2DE and 3DE analyses, and 2D EF was the weakest among the 4 functional indices. A 1% decrease in GLS magnitude was associated with an 11.3% increase in CV mortality risk. CONCLUSIONS GLS predicts mortality better than EF by both 3DE and 2DE analysis, whereas 3D EF is a better predictor than 2D EF. Also, LV shape indices provide additional risk assessment.

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Section: Discussionmentioning

confidence: 77%

mentioning

confidence: 99%

2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape

Medvedofsky

Maffessanti

Weinert

et al. 2018

JACC: Cardiovascular Imaging

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“…Patients with cardiac events had significantly lower prechemotherapy GLS (−15 ± 2.8% vs. −19.7 ± 2.7, P < .001). Interestingly, absolute GLS <−17.5% was associated with a sixfold increase in cardiac events . Among 2234 adult patients with breast and hematological cancers, 158 (7%) had LVEF of 50%‐59% before initiation of chemotherapy .…”

Section: Discussionmentioning

confidence: 99%

“…A few studies in adult patients with cancer have reported the presence of LV dysfunction prior to initiation of chemotherapy. This finding is associated with a higher incidence of symptomatic heart failure and mortality following chemotherapy . Assuncao et al compared 76 adult patients with acute leukemia and 76 patients without cancer matched for age, gender, hypertension, and the presence of diabetes.…”

Section: Introductionmentioning

confidence: 99%

Pediatric malignancies: Is the prechemotherapy left ventricular function normal?

et al. 2019

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Purpose We compared the left ventricular (LV) systolic function in children with cancer before initiation of chemotherapy with matched controls using speckle tracking echocardiography. Methods and results In this retrospective study, we analyzed the echocardiograms of 89 cancer patients before the initiation of chemotherapy and 82 age‐ (8.4 ± 5.2 vs. 8.9 ± 3.9 years, P = .4) and gender‐matched (64% vs. 67%, males, P = .4) healthy controls. Peak systolic LV longitudinal strain (LS) was significantly lower in cancer patients in apical two (−19.8 ± 3.0 vs. −23.5 ± 4.0, P < .001), three (−19.4 ± 3.2 vs. −23.4 ± 4.0, P < .001), and four‐chamber views (−19.7 ± 3.4 vs. −22.5 ± 3.0, P < .001) compared to controls, as was global longitudinal strain (GLS) (−19.8 ± 2.7 vs. −23.4 ± 3.2, P < .001). The prechemotherapy group also had a higher E/e' ratio compared to controls at the septal (9.3 ± 3.9 vs. 7.9 ± 1.7, P = .005) and lateral annulus (7.9 ± 3.3 vs. 5.9 ± 1.4, P < .001) of the mitral valve. The LV ejection fraction was lower in cancer patients compared to controls (63.5 ± 4.9 vs. 66.8 ± 4.1, P < .001), although still within normal limits. There were no differences in LV myocardial performance index (0.30 ± 0.05 vs. 0.30 ± 0.09, P < .65) and shortening fraction (35.8 ± 5.2 vs. 36.1 ± 6.1, P < 0.75) between the two groups. Subgroup analysis showed no difference in LV GLS between patients with solid tumors (n = 56) and blood cancers (n = 33) (GLS −19.2 ± 2.9 vs. 19.5 ± 2.4, P > 0.05). Conclusion Our data demonstrating abnormalities in LV GLS in pediatric cancer patients even prior to initiation of chemotherapy are novel and perplexing. Further longitudinal follow‐up is required to assess the implications of this abnormal LV function in these patients.

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“…Furthermore, for patients who have received 300 mg/m 2 AC, a more frequent surveillance is reasonable. Prospective data already exist in adult patients treated with ACs (Ali et al, 2016) and there is European consensus that speckle tracking is a cornerstone imaging evaluation of patients during and after chemotherapy . The use of echocardiographic assessment of myocardial long axis deformation will be the key tool for detecting even subtle changes in cardiac function (Voigt et al, 2015).…”

Section: Cardiac Surveillancementioning

confidence: 99%

Is it possible to cure childhood acute myeloid leukaemia without significant cardiotoxicity?

2016

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Since cardiotoxicity is a life threatening late effect, a reduction of cardiotoxicity in the treatment of acute myeloid leukaemia (AML) is essential. This review is a compilation of the current knowledge about cardiotoxicity after AML treatment and of how future directions in treatment may affect its incidence. A total of six studies concerning AML and cardiotoxicity were identified. The incidence of late subclinical cardiotoxicity varied between 1·3 and 15·3%, and late clinical cardiotoxicity varied between 1·3 and 9·3%. Cumulative dose of anthracyclines (ACs) and history of relapse were the most common risk factors identified. No conclusions could be drawn about new, potentially less toxic ACs. Differences in treatment data and variations in study populations made comparisons uncertain. The echocardiographic techniques used in the majority of the studies are inferior to more modern echocardiographic methods. This decreases reproducibility and may increase the risk of overestimation of cardiotoxicity. In summary, AML cannot be cured today without ACs. However, some ACs may cause less cardiotoxicity than others. Furthermore there is currently no consensus on equipotent doses of ACs and risk factors for cardiotoxicity. Further research including randomized trials is needed to evaluate whether or not the potentially less cardiotoxic agents fulfil their promise.

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Myocardial Strain Is Associated with Adverse Clinical Cardiac Events in Patients Treated with Anthracyclines

Cited by 89 publications

References 31 publications

2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape

2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape

Pediatric malignancies: Is the prechemotherapy left ventricular function normal?

Is it possible to cure childhood acute myeloid leukaemia without significant cardiotoxicity?

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