Abstract 19306: Myocardial Strain Predicts Adverse Cardiac Events in Patients Treated with Anthracyclines
Introduction: When the cardiotoxicity of anthracyclines is associated with symptoms or with an impaired left ventricular ejection fraction (LVEF), it is often not responsive to heart failure treatment.
Identifying individuals at high risk for major adverse cardiac events (MACE) before the initiation of chemotherapy, especially in patients with hematological malignancies who have high MACE occurrence, may decrease cardiotoxicity. Although decreased baseline LVEF is predictive of MACE, it is a rare occurrence. We compared pre-chemotherapy global longitudinal strain (GLS) and LVEF to stratify patients at high risk for anthracycline-induced cardiac toxicity.
Methods: Patients with hematological cancers treated with anthracyclines who had a pre-chemotherapy echocardiogram between January 2009 and June 2011 at MGH were recruited. Basic demographic data, end-diastolic and end-systolic LV dimensions, LVEF, and GLS (Tomtec Imaging System) were measured. MACE were defined as cardiac death or hospital admission for
symptomatic hear failure or acute coronary syndrome. The prediction of MACE was analyzed by proportional hazard analysis.
Results: Of 257 patients, 26 (10%) experienced a MACE at a median follow up of 1587 days (range; 13-2105 days). The clinical and echocardiographic characteristics of the patients who did or did not develop MACE are summarized in the Table. Diabetes Mellitus (DM), LVEF and GLS were predictive of the occurrence of MACE (P = 0.001, 0.006 and <0.0001 respectively). By multivariable analysis including DM and LVEF, GLS remained the only independent predictor of MACE (HR 1.5 (1.3-1.7) P< 0.0001). A GLS < -17 % was found in 39 patients (15 %) and it was associated with 11 fold increase in MACE (P < 0.0001).
Conclusion: Global longitudinal strain is an effective tool to stratify patients at high risk of MACE after anthracycline therapy and may help tailor oncologic and cardiac treatments to decrease anthracycline-induced cardiotoxicity.
Author Disclosures: M.T. Ali: None. E. Yucel: None. S. Bouras: None. M. Scherrer-Crosbie: None.
- © 2014 by American Heart Association, Inc.