Incremental prognostic value of echocardiographic strain and its association with mortality in cancer patients

Isaac B Rhea; Sarada Uppuluri; Stephen Sawada; Bryan P Schneider; Harvey Feigenbaum

doi:10.1016/j.echo.2015.02.006

Incremental prognostic value of echocardiographic strain and its association with mortality in cancer patients

J Am Soc Echocardiogr. 2015 Jun;28(6):667-73. doi: 10.1016/j.echo.2015.02.006. Epub 2015 Mar 12.

Authors

Isaac B Rhea¹, Sarada Uppuluri², Stephen Sawada³, Bryan P Schneider⁴, Harvey Feigenbaum³

Affiliations

¹ Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: isaac.b.rhea@gmail.com.
² Division of Cardiology, Community Health Network, Indianapolis, Indiana.
³ Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana.
⁴ Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana.

PMID: 25770665
DOI: 10.1016/j.echo.2015.02.006

Abstract

Background: Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort.

Methods: In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle.

Results: Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P < .10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54-2.92; P < .001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14-3.27; P = .014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81-0.97; P = .012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ(2) value after adding GLS (P = .011) to significant clinical variables.

Conclusions: Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.

Keywords: Echocardiography; Mortality; Neoplasia; Prognosis; Speckle-tracking imaging; Strain.

MeSH terms

Comorbidity
Echocardiography / statistics & numerical data*
Female
Humans
Incidence
Indiana / epidemiology
Male
Middle Aged
Neoplasms / diagnostic imaging*
Neoplasms / mortality*
Prognosis
Reproducibility of Results
Risk Assessment
Sensitivity and Specificity
Sex Distribution
Stroke Volume
Survival Analysis
Ventricular Dysfunction, Left / diagnostic imaging*
Ventricular Dysfunction, Left / mortality*