Echocardiography Parameters as Predictors of Left Ventricular Ejection Fraction Reduction in Cancer Patients

Background:
Advances in treatment have led to improved survival of patients with cancer, but with the price of increased morbidity and mortality, mainly due to cardiac causes. Echocardiography is the method of choice for the detection of myocardial dysfunction before, during and after cancer therapy. Currently, diastolic parameters are known to be common among cancer patients, but have not been found to be prognostic for LVEF reduction.

Objectives:
To evaluate Echocardiography parameters as predictors of LVEF reduction (defined as EF reduction ≥5%) in cancer patients.

Methods:
A retrospective, single-center observational study that included 82 consecutive patients evaluated in the Cardio-oncology clinic from January 2015 to September 2016. Clinical and echocardiographic variables were evaluated for all patients. All patients performed at least two echocardiography exams and excluded were patients with reduced LV function (Ejection Fraction<60%) at baseline.

Results:
Among 82 consecutive patients, 18 patients (22%) developed LVEF reduction. Several echocardiography parameters were found to be a significantly predictors of LVEF reduction, including larger LV end diastolic diameter (LVEDD) (49±5mm vs 46±5mm, p=0.002), lower e` septal (6.1±2.2cm/s vs 7.7±2.4 cm/s, p=0.019), lower e` lateral (8±2.5 cm/s vs 10.1±2.7 cm/s, p=0.015), higher E/e` septal (13.8±6.6 cm/s vs 11±5.3 cm/s, p=0.046). However, E/A and deceleration time were not predictive of deterioration in EF (p=0.520, 0.627).

Conclusions:
Early identification of cardiac dysfunction is essential for the prevention of symptomatic heart failure. Our study demonstrates that parameters associated with depressed diastolic function, and larger LV size may identify early cardiac dysfunction which may lead for early cardio protective treatment and prevention of irreversible LVEF reduction and heart failure.