Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Cardiology, Department of Medical Oncology, Health Sciences North (HSN), Division of Clinical Sciences, Northern Ontario School of Medicine (NOSM), Sudbury, Ontario, Canada.
Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
JACC Cardiovasc Imaging. 2022 Aug;15(8):1361-1376. doi: 10.1016/j.jcmg.2022.02.027. Epub 2022 May 11.
Echocardiographic global longitudinal strain (GLS) is a useful measure for detection of cancer treatment-related cardiac dysfunction (CTRCD) but is influenced by blood pressure changes. This limitation may be overcome by assessment of myocardial work (MW), which incorporates blood pressure into the calculation.
This work aims to determine whether myocardial work indices (MWIs) can help diagnose or prognosticate CTRCD.
In this prospective cohort study, 136 women undergoing anthracycline and trastuzumab treatment for HER2+ breast cancer, underwent serial echocardiograms and cardiac magnetic resonance pre- and post-anthracycline and every 3 months during trastuzumab. GLS, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency were measured. CTRCD was defined with cardiac magnetic resonance. Generalized estimating equations quantified the association between changes in GLS and MWIs and CTRCD at the current (diagnosis) and subsequent visit (prognosis). Regression tree analysis was used to explore the combined use of GLS and MW for the diagnostic/prognostic assessment of CTRCD.
Baseline left ventricular ejection fraction (LVEF) was 63.2 ± 4.0%. Thirty-seven (27.2%) patients developed CTRCD. An absolute change in GLS (standardized odds ratio [sOR]: 1.97 [95% CI: 1.07-3.66]; P = 0.031) and GWI (sOR: 1.73 [95% CI: 1.04-2.85]; P = 0.033) were associated with concurrent CTRCD. An absolute change in GLS (sOR: 1.79 [95% CI: 1.22-2.62]; P = 0.003), GWI (sOR: 1.67 [95% CI: 1.20-2.32]; P = 0.003), and GCW (sOR: 1.65 [95% CI: 1.17-2.34]; P = 0.005) were associated with subsequent CTRCD. Change in GWI and GCW demonstrated incremental value over GLS and clinical factors for the diagnosis of concurrent CTRCD. In a small group with a GLS change <3.3% (absolute), and a >21 mm Hg reduction in systolic blood pressure, worsening of GWI identified patients with higher probability of concurrent CTRCD (24.0% vs 5.2%). MWIs did not improve identification of subsequent CTRCD beyond knowledge of GLS change.
GLS can be used to diagnose and prognosticate cardiac magnetic resonance (CMR) defined CTRCD, with additional value from MWIs in selected cases. (Evaluation of Myocardial Changes During Breast Adenocarcinoma Therapy to Detect Cardiotoxicity Earlier With MRI [EMBRACE-MRI]; NCT02306538).
超声心动图整体纵向应变（GLS）是检测癌症治疗相关心功能障碍（CTRCD）的有用指标，但受血压变化的影响。通过评估心肌做功（MW）可以克服这一限制，MW 将血压纳入计算。
本研究旨在确定心肌做功指数（MWI）是否有助于诊断或预测 CTRCD。
在这项前瞻性队列研究中，136 名接受曲妥珠单抗治疗的 HER2+乳腺癌患者接受了蒽环类药物和曲妥珠单抗治疗，在接受蒽环类药物治疗前和治疗后以及每 3 个月进行一次超声心动图和心脏磁共振检查。测量 GLS、整体做功指数（GWI）、整体建设性做功（GCW）、整体浪费功和整体做功效率。使用心脏磁共振定义 CTRCD。广义估计方程量化了 GLS 和 MWI 在当前（诊断）和后续（预后）时与 CTRCD 之间的变化关系。回归树分析用于探讨 GLS 和 MWI 联合用于 CTRCD 的诊断/预后评估。
左心室射血分数（LVEF）的基线值为 63.2±4.0%。37 名（27.2%）患者发生了 CTRCD。GLS 的绝对变化（标准化优势比[sOR]：1.97[95%CI：1.07-3.66]；P=0.031）和 GWI（sOR：1.73[95%CI：1.04-2.85]；P=0.033）与同期 CTRCD 相关。GLS 的绝对变化（sOR：1.79[95%CI：1.22-2.62]；P=0.003）、GWI（sOR：1.67[95%CI：1.20-2.32]；P=0.003）和 GCW（sOR：1.65[95%CI：1.17-2.34]；P=0.005）与后续的 CTRCD 相关。GWI 和 GCW 的变化与 GLS 和临床因素相比，对同期 CTRCD 的诊断具有附加价值。在 GLS 变化<3.3%（绝对值）和收缩压下降>21mmHg的小亚组中，GWI 的恶化可识别出更有可能发生同期 CTRCD 的患者（24.0% vs. 5.2%）。MWI 并不能在 GLS 变化的基础上提高对后续 CTRCD 的识别能力。
GLS 可用于诊断和预测心脏磁共振（CMR）定义的 CTRCD，MWI 在某些情况下具有额外的价值。（乳腺癌治疗期间心肌变化的评估，以便更早地用 MRI 检测心肌毒性[EMBRACE-MRI]；NCT02306538）。
