Usefulness of Global Longitudinal Strain as Predictor for Subclinical Left Ventricular Dysfunction and All-cause Mortality among Active Cancer Patients

Background: Cardiotoxicity among cancer patients has become a leading cause of morbidity and mortality. The most commonly used definition is cancer therapeutic related cardiac dysfunction (CTRCD) defined as a left ventricular ejection fraction reduction of >10%, to a value below 53%. Global longitudinal systolic strain (GLS) has been shown to be more sensitive in detecting early subclinical systolic dysfunction. However, its role in routine follow up of cancer patients, and whether it is associated with all-cause mortality, haven’t been established yet.

Objectives: To evaluate whether reduced GLS is associate with CTRCD development and all-cause mortality among active cancer patients.

Methods: Data were collected as part of the International Cardio-Oncology Registry (ICOR), enrolling prospectively all patients evaluated at the cardio-oncology clinic in our institution. Patients were divided into two groups – Reduced GLS vs. Preserved GLS. Normal GLS was defined as ≤-19% adhered to the standard benchmark set by previous studies.

Results: Among 277 consecutive patients, 91 (33%) patients had reduced GLS at first evaluated echocardiography. Patients with reduced GLS had higher prevalence of cardiovascular risk factors, including hypertension, diabetes mellitus and atrial fibrillation. There were no significant differences regarding the type of cancer treatment. Over a median follow-up period of 13.2 (7.2-19.3) months, 9 (3%) patients developed CTRCD and 35 (13%) patients died. For every 1-unit increment of GLS the risk of CTRCD increased by 25% (OR 1.25, 95%CI 1.09-1.43, p=0.002) and the risk of all-cause mortality by 16% (HR 1.16, 95%CI 1.08-1.25, p<0.001). After adjustment for baseline characteristic, including cardiovascular risk factors and systolic function, reduced GLS emerged as a significant predictor for CTRCD development (OR 6.6 95%CI 1.1-8.8, p=0.037) and all-cause mortality (HR 2.1 95%CI 1.1-4.4, p=0.037).

Conclusions: Reduced GLS is frequent among active cancer patients and can identify patients at increased risk for CTRCD development and all-cause mortality.