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Cardiac mechanics and dysfunction with anthracyclines in the community: results from the PREDICT study
Hari K Narayan1, Wei Wei2, Ziding Feng2
1Division of Cardiology, Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania , USA.
Open Heart
|January 27, 2017
Summary
Changes in myocardial mechanics can diagnose and predict cardiac dysfunction in patients receiving anthracycline chemotherapy. Serial assessments of these measures are crucial for monitoring cardiotoxicity during and after cancer treatment.
Area of Science:
- Cardiology
- Oncology
- Biomedical Engineering
Background:
- Anthracycline chemotherapy can lead to cancer therapeutics-related cardiac dysfunction (CTRCD).
- Early detection and prediction of CTRCD are crucial for patient management.
- Community-based populations require accessible diagnostic tools for cardiotoxicity.
Purpose of the Study:
- To assess the diagnostic and predictive relevance of myocardial mechanics changes in identifying CTRCD.
- To evaluate non-invasively derived cardiac mechanics measures in patients treated with anthracyclines.
- To support broader clinical use of myocardial mechanics assessment for cardiotoxicity monitoring.
Main Methods:
- Quantitative cardiac mechanics measures were derived from echocardiograms in 165 participants of the PREDICT study.
- Measures included strain, strain rate, end-systolic elastance (Eessb), LV volume at an end-systolic pressure of 100 mmHg (V100), effective arterial elastance (Ea), and ventricular-arterial coupling (Ea/Eessb).
- Logistic regression models analyzed diagnostic and prognostic associations with CTRCD, defined as a LV ejection fraction decline ≥10 to <50%.
Main Results:
- 31 participants developed CTRCD by 12 months.
- Longitudinal/circumferential strain and strain rate, V100, Ea, and Ea/Eessb showed significant diagnostic associations with CTRCD.
- Changes in longitudinal strain rate, V100, and Ea from baseline to 6 months were predictive of CTRCD at 12 months.
Conclusions:
- Non-invasive myocardial mechanics measures are valuable for diagnosing and predicting CTRCD in anthracycline-treated patients.
- Findings support the integration of these measures into routine clinical practice.
- Serial assessments of myocardial mechanics are emphasized for monitoring cardiotoxicity during and after cancer therapy.
Keywords:
HEART FAILURE
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