Association between comorbidity burden and subclinical cardiac dysfunction in cancer patients prior to chemotherapy

Subclinical cardiac dysfunction is a growing concern in cancer patients receiving chemotherapy. Early detection before treatment initiation is crucial to prevent overt cardiotoxicity.

This study evaluates the association between comorbidity burden and subclinical cardiac dysfunction, using echocardiographic parameters, in cancer patients prior to chemotherapy.

This retrospective observational study analysed 110 cancer patients who underwent transthoracic echocardiography before chemotherapy. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI) and Karnofsky Performance Status (KPS). Echocardiographic evaluation included Global Longitudinal Strain (GLS), the E/e^' ratio (early transmitral inflow velocity to early diastolic mitral annular velocity) and left atrial volume index (LAVI). Subclinical dysfunction was defined as $\text{GLS}<18\%$ and/or diastolic dysfunction. Spearman's rank correlation and multivariable linear regression were performed.

Abnormal GLS ( $<18\%$ ) was found in 68 patients (61.8%), while 42 patients (38.2%) had normal GLS values. Higher comorbidity burden (CCI) was modestly associated with worse GLS ( $\rho =-0.234$ , $p=0.014$ ) and higher E/e^' ( $\rho =0.215$ , $p=0.024$ ), whereas better functional status (Karnofsky score) correlated with more preserved GLS ( $\rho =0.217$ , $p=0.023$ ). Higher age was independently associated with higher E/e^' ( $B=0.035$ , 95% CI 0.005-0.065, $\beta =0.222$ , $p=0.023$ ), whereas the association between CCI and E/e^' was of borderline significance ( $B=0.186$ , 95% CI -0.024-0.396, $\beta =0.168$ , $p=0.080$ ).

This study showed a significant correlation between comorbidity indices and GLS as well as diastolic function parameters. This suggests that comorbidity burden and functional status are significantly associated with subclinical cardiac abnormalities before chemotherapy.