Myocardial work indexes as independent predictors for cancer treatment-related cardiac dysfunction in anthracycline treated patients

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Abstract Background/Introduction Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) have traditionally been used to chemotherapy-induced cardiotoxicity. Given the fact that anthracyclines are one of the most cardiotoxic classes of chemotherapy, a thorough and accurate cardiac examination and follow-up is required. Therefore, myocardial work (MW) indices may offer a more effective alternative, as they incorporate both myocardial deformation and loading conditions. Purpose The goal was to investigate the usefulness of MW indexes in predicting chemotherapy-induced-cardiotoxicity following anthracycline chemotherapy, and verify if they are better than traditional markers (EF and GLS score). Methods We obtained 2D-ecography LV function parameters (EF, apical rotation, basal rotation, twist, untwist, longitudinal and radial strain, isovolumetric relaxation time-IVRT, E, E’, E/E’, S’), myocardial work parameters (GWI-global work index, GWW- global wasted work, GCW- global constructive work) and laboratory markers (NT-pro-BNP and troponin) in 74 patients aged 50±10,2 treated with anthracyclines for breast cancer, acute lymphatic leukemia, Hodgkin’s and non-Hodgkin’s lymphoma. All parameters were measured before starting treatment with anthracyclines (doxorubicin, epirubicin or idarubicin: cumulative dose=297 mg/m²) and regularly until the end of treatment (12 months). We defined CTR-CD (cancer therapy-related cardiac dysfunction) according to the decrease in values of EF and GLS standardized by the ESC in the asymptomatic, moderate severity class. Results 11 (14,86%) patients developed CTR-CD. Upon analysing the ROC (Receiver Operating Characteristic) curve of each parameter to evaluate which could distinguish CIC the best, the ones having statistical significance were: GWW (AUC=0,778, p=0,0001), S’ (AUC=0,759, p=0,005), radial strain (AUC=0,733, p=0,008), and untwist (AUC=0,083, p=0,019). Multivariate analysis using a standardized Cox regression model (chi-squared=23,379, p=0,0001) showed that, out of these four parameters, the ones correlating the best with the development of CTR-CD were S’ (HR=2,2494, 95%CI=[1,0437;4,8482], p=0,0385), GWW (HR=0,5806, 95%CI=[0,3491;0,9654], p=0,0361) and radial strain (HR=0,5701, 95%CI=[0,3446;0,9430], p=0,0286). Untwist did not achieve statistical significance (HR=2,147, 95%CI=[0,8530;5,4037], p=0,1047). Conclusions Our findings highlight the value of myocardial work indices, especially GWW, as independent predictors for early detection of cancer treatment-related cardiac dysfunction (CTR-CD) in anthracycline-treated patients. Alongside traditional parameters like S' and radial strain, GWW shows significant predictive value, suggesting its inclusion in routine cardiac monitoring for better early identification and management of cardiotoxicity. Further studies are needed to validate these results in larger patient populations.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.