Atorvastatin and left ventricular strain during anthracycline-based chemotherapy

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Anthracyclines can impair left ventricular (LV) deformation, affecting global longitudinal strain (GLS) and global circumferential strain (GCS).
• The potential cardioprotective effect of atorvastatin against these chemotherapy-induced changes is not well understood.
• This study investigates atorvastatin's efficacy in mitigating LV strain reductions during anthracycline treatment.

Purpose of the Study:

• To determine if atorvastatin attenuates anthracycline-induced declines in LV GLS and GCS.
• To assess the impact of atorvastatin on cardiac function during chemotherapy.
• To evaluate atorvastatin as a cardioprotective agent in cancer patients.

Main Methods:

• The STOP-CA trial randomized 300 lymphoma patients receiving anthracyclines to placebo or atorvastatin for 12 months.
• Cardiac MRI with feature tracking (FT) measured LV GLS and GCS at baseline and 12 months.
• Primary endpoint: ≥15% relative decrease in LV GLS; Secondary endpoint: ≥1 SD decrease in LV GCS.

Main Results:

• A ≥15% relative decrease in LV GLS occurred in 19% of the atorvastatin group vs. 28% of the placebo group (P=0.23).
• A ≥1 SD decrease in LV GCS was significantly lower with atorvastatin (25% vs. 42%, OR=0.46, P=0.024).
• LV GCS values at 12 months were significantly lower in the placebo group compared to the atorvastatin group (P=0.012).

Conclusions:

• Atorvastatin significantly reduced the odds of a substantial decline in LV GCS, a marker of adverse cardiac outcomes.
• Atorvastatin did not significantly attenuate the odds of a decline in LV GLS.
• Atorvastatin may offer cardioprotection against specific types of chemotherapy-induced cardiac strain reduction.