Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients
Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (P...
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| Veröffentlicht in: | International journal of environmental research and public health 2022-02, Vol.19 (5), p.2826 |
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| creator | Vaz Ferreira, Vera Mano, Tania Branco Cardoso, Isabel Coutinho Cruz, Madalena Moura Branco, Luísa Almeida-Morais, Luís Timóteo, Ana Galrinho, Ana Castelo, Alexandra Garcia Brás, Pedro Simão, Diana Sardinha, Mariana Gonçalves, António Cruz Ferreira, Rui |
| description | Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4-6 and 12-14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4-6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics. |
| doi_str_mv | 10.3390/ijerph19052826 |
| format | Article |
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Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4-6 and 12-14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4-6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph19052826</identifier><identifier>PMID: 35270517</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Anthracycline ; Atria ; Blood pressure ; Breast cancer ; Breast Neoplasms - complications ; Breast Neoplasms - drug therapy ; Cancer therapies ; Cardiac arrhythmia ; Cardiotoxicity ; Cardiovascular diseases ; Drug dosages ; ErbB-2 protein ; Evaluation ; Female ; Health risks ; Health surveillance ; Heart Diseases ; Heart function ; Humans ; Medical prognosis ; Middle Aged ; Patients ; Radiation therapy ; Risk analysis ; Risk factors ; Software ; Statistical analysis ; Stroke Volume ; Ultrasonic imaging ; Values ; Ventricle ; Ventricular Dysfunction, Left - chemically induced ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Function, Left ; Ventricular Remodeling ; Work stations</subject><ispartof>International journal of environmental research and public health, 2022-02, Vol.19 (5), p.2826</ispartof><rights>2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). 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Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4-6 and 12-14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4-6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.</description><subject>Anthracycline</subject><subject>Atria</subject><subject>Blood pressure</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - complications</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Cancer therapies</subject><subject>Cardiac arrhythmia</subject><subject>Cardiotoxicity</subject><subject>Cardiovascular diseases</subject><subject>Drug dosages</subject><subject>ErbB-2 protein</subject><subject>Evaluation</subject><subject>Female</subject><subject>Health risks</subject><subject>Health surveillance</subject><subject>Heart Diseases</subject><subject>Heart function</subject><subject>Humans</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Radiation therapy</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Stroke Volume</subject><subject>Ultrasonic imaging</subject><subject>Values</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Left - 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Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4-6 and 12-14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4-6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>35270517</pmid><doi>10.3390/ijerph19052826</doi><orcidid>https://orcid.org/0000-0002-5117-7151</orcidid><orcidid>https://orcid.org/0000-0002-8957-9279</orcidid><orcidid>https://orcid.org/0000-0001-8681-7457</orcidid><orcidid>https://orcid.org/0000-0003-4614-4977</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of environmental research and public health, 2022-02, Vol.19 (5), p.2826 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Anthracycline Atria Blood pressure Breast cancer Breast Neoplasms - complications Breast Neoplasms - drug therapy Cancer therapies Cardiac arrhythmia Cardiotoxicity Cardiovascular diseases Drug dosages ErbB-2 protein Evaluation Female Health risks Health surveillance Heart Diseases Heart function Humans Medical prognosis Middle Aged Patients Radiation therapy Risk analysis Risk factors Software Statistical analysis Stroke Volume Ultrasonic imaging Values Ventricle Ventricular Dysfunction, Left - chemically induced Ventricular Dysfunction, Left - diagnostic imaging Ventricular Function, Left Ventricular Remodeling Work stations |
| title | Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients |
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