Simultaneous Left Ventricular Volume and Strain Changes During Chemotherapy Associate With 2‐Year Postchemotherapy Measures of Left Ventricular Ejection Fraction

Abstract

Background Although changes in left ventricular end‐systolic volume ( LVESV ), left ventricular end‐diastolic volume, and global circumferential strain occur during cancer treatment, the relationship of these changes to the 2‐year post–cancer‐treatment measures of left ventricular ejection fraction ( LVEF ) are unknown. Methods and Results In a prospective, continuously recruited cohort of 95 patients scheduled to receive potentially cardiotoxic chemotherapy for breast cancer, lymphoma, or soft tissue sarcoma, measures of left ventricular end‐diastolic volume, LVESV , global circumferential strain, and LVEF were acquired via cardiac magnetic resonance imaging before and then 3 and 24 months after initiating treatment by individuals blinded to all patient identifiers. Participants had an average age of 54±15 years; 68% were women, and 82% were of white race. LVEF declined from 62±7% to 58±9% over the 24 months ( P <0.0001), with 42% of participants experiencing a >5% decline in LVEF at 24 months. Predictors of a 24‐month >5% decline in LVEF included the following factors from baseline to 3 months into treatment: (1) >3‐mL increases in LVESV ( P =0.033), (2) >3‐mL increases in LVESV or 10‐mL declines in left ventricular end‐diastolic volume with little change in LVESV ( P =0.001), or (3) ≥10% deteriorations in global circumferential strain with little change in LVESV ( P =0.036). Conclusion During receipt of potentially cardiotoxic chemotherapy, increases in LVESV , the absence of its deterioration during decreases of left ventricular end‐diastolic volume, or the deterioration of global circumferential strain without a marked decrease in LVESV help identify those who will develop more permanent 2‐year declines in LVEF .

Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): Extended Follow-Up of a 2×2 Factorial, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Candesartan and Metoprolol

“…Our findings suggest that different mechanisms may be at play: the decline in ejection fraction in patients treated with candesartan may be attributable to long-term reverse myocardial remodeling effects of candesartan with reduced end-diastolic volumes whereas in patients not treated with candesartan it may be an expression of decline in myocardial contractility and increased end-systolic volumes. 19 , 21 …”

Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis

“…In patients treated with traditional cytotoxic chemotherapy, reductions in GLS have been associated with a future decrease in LVEF or the development of heart failure, but a less consistent association has been reported for GCS and GRS. 8,30,31 To our knowledge, this is the first study to demonstrate the association of reduced values of GCS and GRS and clinical outcomes in patients who develop myocarditis while on ICI therapy.…”

Myocardial Contractility Pattern Characterization in Radiation-Induced Cardiotoxicity Using Magnetic Resonance Imaging: A Pilot Study with ContractiX

“…As regional changes in myocardial contractility frequently occur before cardiac damage [ 14 , 15 ], regional cardiac dysfunction is potentially reversible, and myocardial strain-derived parameters can be early indicators of cardiotoxicity. This has been demonstrated in studies where MRI-generated strain parameters detected abnormal myocardial function in cancer patients treated with chemotherapy, despite normal systolic function [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Recent results from our preclinical work identified heterogeneous contractility patterns in different LV regions with reduced myocardial strain post-RT [ 15 , 16 ].…”