Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Echocardiography. 2021 Apr;38(4):540-548. doi: 10.1111/echo.15012. Epub 2021 Mar 14.
Increased survival among active cancer patients exposes a wide range of side effects, including cardiotoxicity, manifested by systolic dysfunction and associated with morbidity and mortality. Early diagnosis of subclinical function changes and cardiac damage is essential in the management of these patients. Diastolic dysfunction is considered common among cancer patients; however, its effect on systolic dysfunction or mortality is still unknown.
Data were collected as part of the Israel Cardio-Oncology Registry, enrolling and prospectively following all patients evaluated in the cardio-oncology clinic in the Tel Aviv Sourasky Medical Center. All patients underwent echocardiographic examinations including evaluation of diastolic parameters and global longitudinal strain (GLS). Systolic dysfunction was defined as either an absolute reduction >10% in left ventricular ejection fraction to a value below 53% or GLS relative reduction >10% between the 1st and 3rd echocardiography examinations.
Overall, 190 active cancer patients were included, with a mean age of 58 ± 15 years and a female predominance (78%). During a median follow-up of 243 days (interquartile ranges [IQR]: 164-401 days), 62 (33%) patients developed systolic dysfunction. Over a median follow-up of 789 days (IQR: 521-968 days), 29 (15%) patients died. There were no significant differences in baseline cardiac risk factors between the groups. Using multivariate analysis, E/e' lateral and e' lateral emerged as significantly associated with systolic dysfunction development and all-cause mortality (P = .015).
Among active cancer patients, evaluation of diastolic function may provide an early marker for the development of systolic dysfunction, as well as all-cause mortality.
活跃癌症患者存活率的提高暴露出了广泛的副作用，包括心肌毒性，表现为收缩功能障碍，并与发病率和死亡率相关。早期诊断亚临床功能变化和心脏损伤对于这些患者的治疗至关重要。舒张功能障碍在癌症患者中较为常见；然而，其对收缩功能障碍或死亡率的影响尚不清楚。
数据是作为以色列心脏肿瘤学注册中心的一部分收集的，该中心招募并前瞻性地随访了在特拉维夫索拉斯基医学中心心脏肿瘤学诊所接受评估的所有患者。所有患者均接受超声心动图检查，包括舒张参数和整体纵向应变（GLS）评估。收缩功能障碍定义为左心室射血分数绝对值降低>10%，降至<53%，或 1 次和 3 次超声心动图检查之间的 GLS 相对降低>10%。
共有 190 名活跃癌症患者入组，平均年龄 58 ± 15 岁，女性居多（78%）。在中位随访 243 天（四分位距[IQR]：164-401 天）期间，62 名（33%）患者出现收缩功能障碍。在中位随访 789 天（IQR：521-968 天）期间，29 名（15%）患者死亡。两组患者的基线心脏危险因素无显著差异。多变量分析显示，E/e' 侧壁和 e' 侧壁与收缩功能障碍的发展和全因死亡率显著相关（P =.015）。
在活跃癌症患者中，舒张功能评估可能是收缩功能障碍发展和全因死亡率的早期标志物。
