breast cancer; cancer therapeutics related cardiac dysfunction; ejection fraction; global longitudinal strain; heart failure
Abstract :
[en] AIMS: This study assessed the impact of the strain-guided therapeutic approach on cancer therapy-related cardiac dysfunction (CTRCD) and rate of cancer therapy (CT) interruption in breast cancer. METHODS AND RESULTS: We enrolled 116 consecutive female patients with HER2-positive breast cancer undergoing a standard protocol by EC (epirubicine + cyclophosphamide) followed by paclitaxel + trastuzumab (TRZ). Coronary artery, valvular and congenital heart disease, heart failure, primary cardiomyopathies, permanent or persistent atrial fibrillation, and inadequate echo-imaging were exclusion criteria. Patients underwent an echo-Doppler exam with determination of ejection fraction (EF) and global longitudinal strain (GLS) at baseline and every 3 months during CT. All patients developing subclinical (GLS drop >15%) or overt CTRCD (EF reduction <50%) initiated cardiac treatment (ramipril+ carvedilol). In the 99.1% (115/116) of patients successfully completing CT, GLS and EF were significantly reduced and E/e' ratio increased at therapy completion. Combined subclinical and overt CTRCD was diagnosed in 27 patients (23.3%), 8 at the end of EC and 19 during TRZ courses. Of these, 4 (3.4%) developed subsequent overt CTRCD and interrupted CT. By cardiac treatment, complete EF recovery was observed in two of these patients and partial recovery in one. These patients with EF recovery re-started and successfully completed CT. The remaining patient, not showing EF increase, permanently stopped CT. The other 23 patients with subclinical CTRCD continued and completed CT. CONCLUSION: These findings highlight the usefulness of 'strain oriented' approach in reducing the rate of overt CTRCD and CT interruption by a timely cardioprotective treatment initiation.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Santoro, Ciro
Esposito, Roberta
Lembo, Maria
Sorrentino, Regina
De Santo, Irene
Luciano, Federica
Casciano, Ofelia
Giuliano, Mario
De Placido, Sabino
Trimarco, Bruno
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Strain-oriented strategy for guiding cardioprotection initiation of breast cancer patients experiencing cardiac dysfunction.
Publication date :
2019
Journal title :
European Heart Journal. Cardiovascular Imaging
ISSN :
2047-2404
eISSN :
2047-2412
Publisher :
Oxford University Press, United Kingdom
Volume :
20
Issue :
12
Pages :
1345-1352
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
Siegel R, De Santis C, Virgo K, Stein K, Mariotto A, Smith T et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012;62:220-41.
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374-403.
Ewer MS, Ewer SM. Cardiotoxicity of anticancer treatments. Nat Rev Cardiol 2015;12:620.
Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS et al.; ASCO Cancer Survivorship Expert Panel. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007;25:3991-4008.
Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:1063-93.
Madeddu C, Deidda M, Piras A, Cadeddu C, Demurtas L, Puzzoni M et al. Pathophysiology of cardiotoxicity induced by nonanthracycline chemotherapy. J Cardiovasc Med 2016;17(Suppl 1):S12-18.
Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc 2014;89:1287-306.
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M et al.; ESC Scientific Document Group. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016;37:2768-801.
Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popovic ZB, Marwick TH et al. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. J Am Coll Cardiol 2013;61:77-84.
Charbonnel C, Convers-Domart R, Rigaudeau S, Taksin AL, Baron N, Lambert J et al. Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity. Eur Heart J Cardiovasc Imaging 2017;18:392-401.
Esposito R, Galderisi M, Santoro C, Imbriaco M, Riccio E, Pellegrino MA et al.; AFFIINITY Group. Prominent longitudinal strain reduction of left ventricular basal segments in treatment-naïve Anderson-Fabry disease patients. Eur Heart J Cardiovasc Imaging 2019;20:438-45.
Lembo M, Esposito R, Lo Iudice F, Santoro C, Izzo R, De Luca N et al. Impact of pulse pressure on left ventricular global longitudinal strain in normotensive and newly diagnosed, untreated hypertensive patients. J Hypertens 2016;34: 1201-7.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;15: 233-70.
Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G et al.; 2016-2018 EACVI Scientific Documents Committee; 2016-2018 EACVI Scientific Documents Committee. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017;18:1301-10.
de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20:251-60.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al. Recommendations for the Evaluation of left ventricular diastolic function by Echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016;17:1321-60.
Alcidi GM, Esposito R, Evola V, Santoro C, Lembo M, Sorrentino R et al. Normal reference values of multilayer longitudinal strain according to age decades in a healthy population: a single-centre experience. Eur Heart J Cardiovasc Imaging 2018;19:1390-6.
Cardinale D, Sandri MT, Martinoni A, Tricca A, Civelli M, Lamantia G et al. Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J Am Coll Cardiol 2000;36:517-22.
Cardinale D, Sandri MT, Martinoni A, Borghini E, Civelli M, Lamantia G et al. Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy. Ann Oncol 2002;13:710-5.
Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation 2004;109:2749-54.
Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015;131:1981-8.
Salvatici M, Cardinale D, Botteri E, Bagnardi V, Mauro C, Cassatella MC et al. TnI-Ultra assay measurements in cancer patients: comparison with the conventional assay and clinical implication. Scand J Clin Lab Invest 2014;74: 385-91.
Santoro C, Arpino G, Esposito R, Lembo M, Paciolla I, Cardalesi C et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancer patients: a balance with feasibility. Eur Heart J Cardiovasc Imaging 2017; 18:930-6.
Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt JU. Head-tohead comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE Inter-Vendor Comparison Study. J Am Soc Echocardiogr 2015;28:1171-81.
Bergler-Klein J. Strain and left ventricular volumes for predicting cardiotoxicity: a life-saving approach in anthracycline cancer treatment? Eur Heart J Cardiovasc Imaging 2015;16:968-9.
Galderisi M, Trimarco B. Global longitudinal strain: a novel hallmark of cardiac risk in arterial hypertension. J Hypertens 2016;34:1050-1.
Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014;100:1673-80.
Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol 2014;63:2751-68.
Negishi K, Negishi T, Hare JL, Haluska BA, Plana JC, Marwick TH. Independent and incremental value of deformation indices for prediction of trastuzumabinduced cardiotoxicity. J Am Soc Echocardiogr 2013;26:493-8.
Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging 2012;5: 596-603.
Negishi K, Negishi T, Haluska BA, Hare JL, Plana JC, Marwick TH. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging 2014;15:324-31.
Moja L, Tagliabue L, Balduzzi S, Parmelli E, Pistotti V, Guarneri V et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev 2012;4:CD006243.
Negishi T, Thavendiranathan P, Negishi K, Marwick TH, Aakhus S, Murbræch K et al. Rationale and design of the strain surveillance of chemotherapy for improving cardiovascular outcomes (SUCCOUR) trial. JACC Cardiovasc Imaging 2018;11:1098-105.
Lenihan DJ, Massey MR, Baysinger KB, Adorno CL, Warneke CL, Steinert D et al. Superior detection of cardiotoxicity during chemotherapy using biomarkers. J Card Fail 2007;13:S151.
Witteles RM. Biomarkers as predictors of cardiac toxicity from targeted cancer therapies. J Card Fail 2016;22:459-64.
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2015;16: 1-11.