Myocardial Strain Is Associated with Adverse Clinical Cardiac Events in Patients Treated with Anthracyclines

Autor: Elkan F. Halpern, Lin Wang, Evin Yucel, Mohammed Ali, Marielle Scherrer-Crosbie, Hong-wen Fei M.D., Souhila Bouras
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
Anthracycline
medicine.medical_treatment
Comorbidity
030204 cardiovascular system & hematology
Sensitivity and Specificity
03 medical and health sciences
0302 clinical medicine
Risk Factors
Elastic Modulus
Internal medicine
medicine
Humans
Anthracyclines
Radiology
Nuclear Medicine and imaging
030212 general & internal medicine
Survival rate
Aged
Retrospective Studies
Heart Failure
Cardiotoxicity
Chemotherapy
Ejection fraction
business.industry
Incidence
Hazard ratio
Reproducibility of Results
Heart
Retrospective cohort study
Middle Aged
medicine.disease
humanities
Survival Rate
Death
Sudden
Cardiac
Treatment Outcome
Massachusetts
Hematologic Neoplasms
Heart failure
Cardiology
Elasticity Imaging Techniques
Female
Shear Strength
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of the American Society of Echocardiography. 29:522-527.e3
ISSN: 0894-7317
DOI: 10.1016/j.echo.2016.02.018
Popis: Anthracycline-induced symptomatic heart failure is often irreversible, underlining the usefulness of pretreatment risk assessment. Global longitudinal strain (GLS) before or after chemotherapy is associated with a later decrease in left ventricular ejection fraction (LVEF); however, whether prechemotherapy GLS is associated with symptomatic heart failure and cardiac death in patients treated with anthracyclines is unknown.Patients with hematologic cancers treated with anthracyclines who underwent prechemotherapy echocardiography between November 2006 and June 2011 were retrospectively recruited. Basic demographic data, end-diastolic and end-systolic left ventricular volumes, LVEF, and GLS were measured. Clinical cardiac events (CEs) were defined as cardiac death or symptomatic heart failure. The association of prechemotherapy parameters with CEs was analyzed using proportional hazard analysis.Over a median follow-up period of 1,593 days (range, 13-2,891 days) after the start of chemotherapy, 28 of 450 patients (6%) experienced CEs. Prechemotherapy LVEF and GLS were lower in patients with CEs compared with those without CEs (58 ± 10% vs 62 ± 7% [P = .005] and -15.0 ± 2.8% vs -19.7 ± 2.7% [P .0001], respectively). Diabetes (hazard ratio [HR], 7.06; P .0001), hypertension (HR, 2.22; P = .04), LVEF (HR, 0.93; P = .005), and GLS (HR, 1.47; P .0001) were associated with CEs. After controlling for clinical variables, prechemotherapy GLS remained independently associated with CEs (P .0001). GLS less than the absolute value of -17.5% was found in 105 patients (23%) and was associated with a sixfold increase in CEs (P .0001).Prechemotherapy GLS is an effective tool to stratify patients at high risk for CEs after anthracycline therapy and may help tailor treatments to decrease anthracycline-induced cardiotoxicity.
Databáze: OpenAIRE
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