Imaging Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Eur Heart J. 2024 Nov 7;45(41):4414-4424. doi: 10.1093/eurheartj/ehae574.
The detection of cancer therapy-related cardiac dysfunction (CTRCD) by reduction of left ventricular ejection fraction (LVEF) during chemotherapy usually triggers the initiation of cardioprotective therapy. This study addressed whether the same approach should be applied to patients with worsening of global longitudinal strain (GLS) without attaining thresholds of LVEF.
Strain surveillance during chemotherapy for improving cardiovascular outcomes (SUCCOUR-MRI) was a prospective multicentre randomized controlled trial involving 14 sites. Of 355 patients receiving anthracyclines with normal baseline LVEF, 333 patients (age 59 ± 13 years, 79% women) with at least one other CTRCD risk factor, able to undergo magnetic resonance imaging (MRI), GLS, and three-dimensional echocardiography were tracked over 12 months. A total of 105 patients (age 59 ± 13 years, 75% women, 69% breast cancer) developing GLS-CTRCD (>12% relative reduction of GLS without a change in LVEF) were randomized to cardioprotection with neurohormonal antagonists vs. usual care. The primary endpoint was 12-month change in MRI-LVEF; the secondary endpoint was MRI-LVEF-defined CTRCD.
During follow-up, two patients died, and two developed heart failure. Most patients were randomized at 3 months (62%). Median doses of angiotensin inhibition/blockade and beta-blockade were 75% and 50% of respective targets; 21 (43%) had side-effects attributed to cardioprotection. Due to a smaller LVEF change from baseline with cardioprotection than usual care (-2.5 ± 5.4% vs. -5.6 ± 5.9%, P = .009), follow-up LVEF was higher after cardioprotection (59 ± 5% vs. 55 ± 6%, P < .0001). After adjustment for baseline LVEF, the mean (95% confidence interval) difference in the change in LVEF between the two groups was -3.6% (-1.8% to -5.5%, P < .001). After cardioprotection, 1/49 patients developed 12-month LVEF-CTRCD, compared to 6/56 in usual care (P = .075). Global longitudinal strain improved at 3 months post-randomization in the cardioprotection group, with little change with usual care.
In patients with isolated GLS reduction after anthracyclines, cardioprotection is associated with better preservation of 12-month MRI-LVEF compared with usual care.
化疗期间左心室射血分数（LVEF）降低通常会触发心脏保护治疗，从而检测到癌症治疗相关的心脏功能障碍（CTRCD）。本研究旨在探讨对于 LVEF 未达到阈值但 GLS 恶化的患者，是否应采用相同的方法。
化疗期间的应变监测以改善心血管结局（SUCCOUR-MRI）是一项前瞻性多中心随机对照试验，涉及 14 个地点。在接受蒽环类药物治疗且基线 LVEF 正常的 355 例患者中，共有 333 例（年龄 59±13 岁，79%为女性）至少存在其他一个 CTRCD 风险因素，能够接受磁共振成像（MRI）、GLS 和三维超声心动图检查，随访 12 个月。共有 105 例（年龄 59±13 岁，75%为女性，69%为乳腺癌）发生 GLS-CTRCD（GLS 相对降低超过 12%，而 LVEF 无变化）的患者被随机分配接受神经激素拮抗剂的心脏保护治疗与常规治疗。主要终点是 MRI-LVEF 的 12 个月变化；次要终点是 MRI-LVEF 定义的 CTRCD。
随访期间，有 2 例患者死亡，2 例发生心力衰竭。大多数患者在 3 个月（62%）时被随机分组。血管紧张素抑制/阻断和β受体阻滞剂的中位剂量分别为各自靶目标的 75%和 50%；21 例（43%）出现归因于心脏保护的副作用。由于心脏保护治疗与常规治疗相比，LVEF 从基线的变化较小（-2.5±5.4%与-5.6±5.9%，P=0.009），因此心脏保护治疗后 LVEF 更高（59±5%与 55±6%，P<0.0001）。在调整基线 LVEF 后，两组间 LVEF 变化的平均（95%置信区间）差异为-3.6%（-1.8%至-5.5%，P<0.001）。心脏保护治疗后，49 例患者中有 1 例（2%）发生 12 个月的 LVEF-CTRCD，而常规治疗组中有 6 例（10%）（P=0.075）。在随机分组后 3 个月，心脏保护组的 GLS 改善，而常规治疗组的 GLS 变化不大。
在接受蒽环类药物治疗后出现孤立性 GLS 降低的患者中，与常规治疗相比，心脏保护治疗与 12 个月 MRI-LVEF 的更好保留相关。
