Subclinical left ventricular dysfunction in men under androgen deprivation therapy for prostate cancer, revealed by speckle-tracking-derived parameters, repolarization, and myocardial injury markers

Andrei C D Gheorghe; Ana Ciobanu; Andreea S Hodorogea; George D Radavoi; Viorel Jinga; Alexandru S C Rascu; Ioan T Nanea; Gabriela S Gheorghe

doi:10.1111/echo.15043

Subclinical left ventricular dysfunction in men under androgen deprivation therapy for prostate cancer, revealed by speckle-tracking-derived parameters, repolarization, and myocardial injury markers

Echocardiography. 2021 Apr;38(4):632-640. doi: 10.1111/echo.15043. Epub 2021 Mar 25.

Authors

Andrei C D Gheorghe^{1

2}, Ana Ciobanu^{1

2}, Andreea S Hodorogea^{1

2}, George D Radavoi^{1

3}, Viorel Jinga^{1

3}, Alexandru S C Rascu^{1

3}, Ioan T Nanea^{1

2}, Gabriela S Gheorghe^{1

2}

Affiliations

¹ Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
² Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, Bucharest, Romania.
³ Department of Urology, Theodor Burghele Clinical Hospital, Bucharest, Romania.

Abstract

Objective: To analyze global left ventricular longitudinal strain (GLS), mechanical dispersion (MD), electrocardiographic repolarization, and myocardial injury markers changes during androgen deprivation therapy (ADT) and subsequent hypogonadism in men with advanced prostate cancer.

Methods: We included 31 patients 69.7 ± 7.3 years old, in sinus rhythm, with stable cardiac conditions and evaluated them by echocardiography, electrocardiography, and blood sampling for high sensitivity cardiac troponin I (hs-cTnI), and N-terminal pro-brain natriuretic peptide (NTproBNP), at ADT initiation (M0) and after 6 months of treatment (M1). Peak longitudinal strain by speckle-tracking echocardiography was assessed in 17 left ventricular segments and averaged to GLS. Standard deviation of time intervals from the start of Q/R on electrocardiogram to peak longitudinal strain in the 17 segments (MD_SD ), and the difference between the longest and shortest time-to-peak strain intervals (MD_delta ) were calculated as indices of MD. Fridericia corrected electrocardiographic repolarization parameters were analyzed as follows: QT interval (QTc), mean and maximum values of Tpeak-Tend interval (Tpe), and Tpe/QT ratio, Tpe dispersion (Tped).

Results: Significant impairments of the following parameters were registered between M0 and M1: GLS (%) (-16.93 ± 3.89; -14.43 ± 3.57, P < .001), MD_SD (ms) (77.4 ± 21.4; 89 ± 27, P = .004), MD_delta (ms) (225.3 ± 78.3; 259.9 ± 108.4, P = .02), QTc (ms) (458.8 ± 43.4; 485.6 ± 45.1, P = .01), maxTpe/QT (0.246 ± 0.04; 0.268 ± 0.04, P = .01), maxTpe (ms) (105.4 ± 23.2; 119.5 ± 26.4 P = .01), meanTpe (ms) (83.3 ± 16.8; 90.7 ± 19.3, P = .02), and hs-cTnI (ng/mL) (4.6 ± 5.4; 5.4 ± 6.4, P = .01). Mean serum testosterone level at M1 was 0.1 ± 0.13 ng/mL. The patients' clinical cardiological status remained stable during follow-up.

Conclusions: ADT and subsequent hypogonadism induce subclinical alterations in GLS, MD, electrocardiographic repolarization parameters, and hs-cTnI during the first 6 months of treatment.

Keywords: brain natriuretic peptide; cardiac toxicity; left ventricular function; myocardial strain; transthoracic echocardiography.

MeSH terms

Aged
Androgen Antagonists / adverse effects
Androgens
Electrocardiography
Humans
Male
Middle Aged
Prospective Studies
Prostatic Neoplasms* / complications
Prostatic Neoplasms* / drug therapy
Ventricular Dysfunction, Left* / chemically induced
Ventricular Dysfunction, Left* / diagnosis

Substances

Androgen Antagonists
Androgens