SPC365

Myocardial work brings a new insight into left ventricule remodelling in cardiooncology patients

Session: CO 26 - Populações especiais
Speaker: Vera Vaz Ferreira

Congress: CPC 2021
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.6 Cardio-Oncology
Session Type: Comunicações Orais
FP Number: ---
Authors: Vera Ferreira; Madalena Coutinho Cruz; Luisa Moura Branco; Ana Galrinho; Ana Teresa Timóteo; Pedro Rio; Luís Almeida Morais; Sílvia Aguiar Rosa; Ana Leal; Sónia Oliveira; Alexandra Castelo; Pedro Garcia Brás; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Serial echocardiographic assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) is the gold standard screening method for cancer therapeutics-related cardiac dysfunction (CTRCD). &nbsp;N<span style="background-color:white"><span style="color:#111111">on-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages, as it incorporates measurements of myocardial deformation and LV pressure.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#111111">Purpose: To evaluate the </span></span>impact of cardiotoxic treatments<span style="background-color:white"><span style="color:#111111"> in MW indices.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Prospective study of female breast cancer patients (P) submitted to therapy (TH) who underwent serial monitoring by 2D, 3D transthoracic echocardiography (TTE) and concomitant blood pressure assessment. P were evaluated at T0, T1 and T2 (before, &ge;6 and &ge;12 months after starting TH). PSL analysis allowed the calculation of the following indices: Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE). CTRCD was defined as an absolute decrease in 2D LVEF &gt; 10% to a value &lt; 54% or a relative decrease in 2D GLS &gt; 15%, according to literature. &nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: 122 patients (mean age 54.7 &plusmn; 12.0 years), mostly treated with anthracyclines (77.0%, cumulative dose 268.6&plusmn;71.8mg/m<sup>2</sup>), anti-HER (75.4%) and radiotherapy (77.0%) were included.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">2D and 3D LVEF were significantly reduced during TH, however remaining within the limits of normality (2D LVEF T0-T1 64.2 &plusmn;7.6 vs 61.1&plusmn;8.2%, p=0.006 and 3D LVEF T0-T1 60.2&plusmn;6.7 vs 56.9 &plusmn;6.3%, p=0.022). 2D GLS was also more impaired at T1 (-19.8&plusmn;2.7% vs -18.5&plusmn;3.0%, p=0.003).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All MW indices were significantly reduced at T1 compared to baseline (GWI 1756.9&plusmn;319.2 vs 1614.3&plusmn;338.5mmHg%, p=0.005; GCW 2105.6&plusmn;352.0 vs 1970.5&plusmn;376.2 mmHg%, p=0.015; GWW 121.1&plusmn;66.6 vs 161.1&plusmn;84.1 mmHg%, p=0.001; GWE 93.5&plusmn;3.1 vs 91.1&plusmn;4.5%, p=0.001). Between T1 and T2 no statistical difference was found but a partial recovery of parameters was observed when comparing T2 to T0 (GWI (T2) 1650.6&plusmn;357.5 mmHg%, p=0.035; GCW (T2) <span style="color:black">2013.3&plusmn;379.3</span> mmHg%<span style="color:black">, p=0.086; GWW (T2) 148.0&plusmn;85.0</span> mmHg%, p=0.02 and GWE (T2) <span style="color:black">92.0&plusmn;4.7</span>%, p=0.012).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a mean follow-up of 14.9 &plusmn; 9.3 months, 36 patients (29.5%) developed CTRCD.&nbsp; P presenting CTRCD revealed a significant decrease in GWI and GWE at T1 comparing with women without CTRCD (GWI 1.8&plusmn;21.6 vs -14.2&plusmn;18.5%, p=0.004 and GWE -1.0 &plusmn;3.0 vs -3.6 &plusmn;3.9%, p=0.005). GWW had a substantially increase at T1 in P with cardiotoxicity (27.6&plusmn;76.3% vs 64.1 &plusmn; 68.0%, p=0.051).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Left ventricular systolic function study with MW showed a reduction in cardiac performance with a peak at 6 months from the start of chemotherapy and partial recovery after term. Assessment of myocardial deformation parameters, namely MW, proved to be a useful tool for a better characterisation of cardiac remodelling, and could enhance patient selection for cardioprotective therapeutics. </span></span></p>