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

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 bee...

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Bibliographic Details
Published in:Clinical research in cardiology 2020-02, Vol.109 (2), p.255-262
Main Authors: Laufer-Perl, Michal, Arnold, Joshua H., Mor, Liat, Amrami, Nadav, Derakhshesh, Matthew, Moshkovits, Yonatan, Sadeh, Ben, Arbel, Yaron, Topilsky, Yan, Rozenbaum, Zach
Format: Article
Language:English
Subjects:
Cancer
Cancer therapies
Cardiology
Cardiotoxicity
Cardiovascular diseases
Confidence intervals
Echocardiography
Health risks
Medicine
Medicine & Public Health
Morbidity
Oncology
Original Paper
Risk analysis
Risk factors
Therapy
Ventricle
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Summary: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. Graphic abstract
ISSN:1861-0684
1861-0692
DOI:10.1007/s00392-019-01508-9