Deterioration in myocardial work indices precedes changes in global longitudinal strain following anthracycline chemotherapy

Junzhen Zhan; Jef Van den Eynde; Kyla Cordrey; Rita Long; David A Danford; Allison G Hays; Benjamin T Barnes; Shelby Kutty

doi:10.1016/j.ijcard.2022.06.067

Deterioration in myocardial work indices precedes changes in global longitudinal strain following anthracycline chemotherapy

Int J Cardiol. 2022 Sep 15:363:171-178. doi: 10.1016/j.ijcard.2022.06.067. Epub 2022 Jun 30.

Authors

Junzhen Zhan¹, Jef Van den Eynde², Kyla Cordrey¹, Rita Long¹, David A Danford¹, Allison G Hays³, Benjamin T Barnes¹, Shelby Kutty⁴

Affiliations

¹ The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
² The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Cardiovascular Sciences, KU Leuven, Belgium; Congenital and Structural Cardiology, UZ Leuven, Leuven, Belgium.
³ Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁴ The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA. Electronic address: skutty1@jhmi.edu.

PMID: 35780931
DOI: 10.1016/j.ijcard.2022.06.067

Abstract

Background: Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) have conventionally been used for surveillance of cardiac function after cancer therapy, but indices of myocardial work (MW) are potentially superior for this purpose because they take into account both myocardial deformation and loading conditions.

Objectives: We aimed to investigate the usefulness of MW in the follow-up of children and young adults following anthracycline chemotherapy.

Methods: Conventional markers of LV function (LV fractional shortening [LVFS], LVEF, GLS) and MW indices (global work index [GWI], global constructive work [GCW], global wasted work [GWW], and global work efficiency [GWE]) were obtained from 2342 echocardiographic examinations in 598 patients (354 male, 12.2 [4.7-17.3] years at initiation of chemotherapy).

Results: GWI, GCW, GLS, LVFS, and LVEF all deteriorated significantly during and after anthracycline chemotherapy, while GWW decreased and GWE was preserved. On multivariable analysis, MW indices were correlated with conventional markers of LV function and with clinical information relating to underlying malignancy and chemotherapy. Cox regression analysis revealed that similar levels of deterioration in GWW, GWI, and GCW preceded those in GLS, LFS, and LVEF.

Conclusions: Non-invasive MW indices correlate well with conventional markers of LV function. Indices of MW appear to provide an earlier and more sensitive marker of progression towards chemotherapy-related cardiac dysfunction. Future studies are warranted to validate whether the incorporation of non-invasive MW into the routine clinical surveillance in patients after chemotherapy would improve outcomes.

Keywords: Cardio-oncology; Chemotherapy; Echocardiography; Myocardial work; Oncology; Pediatrics.

MeSH terms

Anthracyclines* / adverse effects
Antibiotics, Antineoplastic / adverse effects
Child
Echocardiography
Humans
Male
Myocardium
Stroke Volume
Ventricular Function, Left*

Substances

Anthracyclines
Antibiotics, Antineoplastic