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Chemotherapy-related cardiac dysfunction: the usefulness of myocardial work indices

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Abstract

Aims: The role of left ventricular global longitudinal strain (GLS) in the diagnosis of subclinical cardiac damage induced by anticancer drugs is now consolidated. Considering some strain disadvantages such as the dependence on the haemodynamic loading conditions, the aim of our study was to investigate the usefulness of non-invasive myocardial work indices (MWI) derived from pressure–strain analysis, in the early diagnosis of cardiotoxicity. Methods and results: We enrolled 61 consecutive patients with breast cancer undergoing adjuvant treatment with anthracycline-containing chemotherapy followed by taxane + trastuzumab. Patients underwent a cardiological evaluation with 2D echocardiography including measurement of the left ventricular ejection fraction (LVEF) and other conventional parameters of systolic and diastolic function, GLS and MWI at baseline (T0), 3 months (T1) and 6 months (T2) after starting chemotherapy. At T1 and T2, we did not find a significant reduction in LVEF but we found a significant reduction in GLS and MWI (p value < 0.05). In addition, at T2, 31% of patients developed subclinical cardiac dysfunction defined as a relative decrease ≥ 12% of GLS from baseline. Global work index (GWI), global constructive work (GCW) and global work efficiency (GWE) decreased significantly in both patients with subclinical dysfunction and in those without subclinical dysfunction (p value < 0.05). Patients with subclinical dysfunction at T2 showed lower values of GCW at T0. Conclusion: MWI changed significantly during chemotherapy and appeared to alter precociously compared to GLS. Therefore, a multiparametric approach including left ventricular GLS and MWI measurements should be used in the evaluation of patients undergoing cardiotoxic antineoplastic treatment.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Division of Cardiology, University Hospital “Paolo Giaccone”, Palermo, Italy

    Daniela Di Lisi & Giuseppina Novo

  2. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy

    Daniela Di Lisi, Girolamo Manno, Cristina Madaudo, Rita Cristina Myriam Intravaia, Alfredo Ruggero Galassi & Giuseppina Novo

  3. Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127, Palermo, Italy

    Clarissa Filorizzo, Lorena Incorvaia & Antonio Russo

Authors
  1. Daniela Di Lisi
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  2. Girolamo Manno
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  3. Cristina Madaudo
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  4. Clarissa Filorizzo
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  5. Rita Cristina Myriam Intravaia
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  6. Alfredo Ruggero Galassi
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  7. Lorena Incorvaia
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  8. Antonio Russo
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  9. Giuseppina Novo
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Contributions

Di Lisi D wrote the main manuscript. Manno G, Filorizzo C, Intravaia R collected data.Madaudo C performed statistical analysis.Incorvaia L, Russo A, Galassi AR and Novo G supervisioned the manuscript.

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Correspondence to Daniela Di Lisi.

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Di Lisi, D., Manno, G., Madaudo, C. et al. Chemotherapy-related cardiac dysfunction: the usefulness of myocardial work indices. Int J Cardiovasc Imaging 39, 1845–1853 (2023). https://doi.org/10.1007/s10554-023-02897-9

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  • DOI: https://doi.org/10.1007/s10554-023-02897-9

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