Atorvastatin and left ventricular strain during anthracycline-based chemotherapy

Anthracyclines can be associated with impaired left ventricular (LV) deformation, measured by global longitudinal strain (GLS) and global circumferential strain (GCS). Whether atorvastatin protects against anthracycline-induced reductions in GLS and GCS is unknown. We investigated whether atorvastatin attenuates these declines during anthracycline-based chemotherapy.

In the STOP-CA trial, participants with lymphoma treated with anthracyclines were randomized to placebo (n = 150) or atorvastatin (n = 150) for 12 months. Cardiac MRI-derived GLS and GCS measurements were performed at baseline and 12 months using feature tracking (FT). The primary endpoint was a ≥ 15% relative decrease in LV GLS. The secondary endpoint was a ≥ 1SD decrease in LV GCS.

Of 300 participants, 188 (mean age 51 ± 16 years, 48% female, 93 with atorvastatin) had paired LV GLS, and 177 had paired LV GCS data with similar values in both groups at baseline. A ≥ 15% relative decrease in LV GLS was observed among 19% in the atorvastatin and 28% in the placebo group (P = 0.23). The proportion of participants with a ≥ 1SD decrease (3.2% unit) in LV GCS at 12 months was lower in the atorvastatin group (25% vs. 42%, Odds Ratio: 0.46, 95% Confidence Interval 0.24-0.87, P = 0.024). At 12 months, LV GCS values were lower in the placebo group (20.2 ± 3.3% vs. 19.3 ± 2.7%, P = 0.012).

Atorvastatin decreased the odds of a significant decline in LV GCS, a predictor of adverse cardiac outcomes in patients undergoing anthracycline-based chemotherapy. Atorvastatin did not significantly attenuate the odds of a decline in LV GLS. (Clinical trial registration: NCT02943590; https://clinicaltrials.gov/study/NCT02943590).