05 Feb Identifying Cardiac Strain Early May Minimize Heart Failure in Chemotherapy Patients
MedicalResearch.com Interview with:
Paaladinesh Thavendiranathan MD, SM
Ted Rogers Centre for Heart Research and the Division of Cardiology
Peter Munk Cardiac Center, University Health Network,
Joint Department of Medical Imaging, , University Health Networ
Toronto, Ontario, Canada
MedicalResearch.com: What is the background for this study?
Response: Anthracyclines are a common class of chemotherapy drugs used to treat patients with blood, breast, and many other cancers. Patients receiving anthracycline based cancer therapy who are deemed to be high cardiovascular risk either based on their age or presence of cardiovascular risk factors are at risk of developing heart failure. In high risk patients this risk of heart failure could be between 5-10% over a 5 year period depending on the treatment regimens used. Therefore it is possible that the cancer patient of today can become a heart failure patient of tomorrow. These cancer treatments are however very effective against the cancer. So it is important to find strategies to prevent the development of heart failure. Usually oncologists and cardiologists work together to monitor patients during and after cancer therapy using surveillance strategies.
One such strategy is to repeat heart ultrasounds to identify heart dysfunction early followed by initiation of cardioprotective therapy. Traditional approaches measure left ventricular ejection (LVEF) as a metric of heart function. However, we have learned that with this approach it may be too late when a change in LVEF is identified. Global longitudinal strain (GLS) is a newer echocardiography method that appears to identify heart dysfunction earlier before a major change in LVEF occurs. However, whether initiation of cardioprotective therapy when a change in GLS is identified can prevent a reduction in heart function and development of cardiotoxicity (significant change to heart function) is unknown.
The SUCCOUR trial is an international, multicenter randomized controlled trial that compared using an LVEF based approach to surveillance (arm 1) versus the addition of GLS based surveillance (arm 2) in high risk patients receiving anthracycline based therapy. The study enrolled 153 patients in the LVEF arm and 154 patients in the GLS arm. Majority of the patients (~90%) had breast cancer.
MedicalResearch.com: What are the main findings?
Response: The study demonstrated that using GLS based surveillance heart function changes are identified earlier and in twice as many patients when compared to LVEF based surveillance. This means twice as many patients received cardioprotective therapy in the GLS arm.
The primary outcome was a comparison of change in heart function between pre-cancer treatment and 1 year later measured using LVEF. This comparison included patients regardless of whether heart dysfunction was identified or cardioprotective therapy was initiated. The study did not identify a difference. However, when patients who received cardioprotective therapy were compared those who were followed and treated using the GLS based surveillance had a significantly lower changes in heart function (measured by LVEF) at 1 year.
Also when the more clinically important outcome of cardiotoxicity (significant change to heart function) was studied, there was a significantly lower risk in patients who were initiated on cardioprotective therapy based on GLS based surveillance.
MedicalResearch.com: What should readers take away from your report?
Response: When high cardiovascular risk patients receiving anthracycline based chemotherapy, sequential heart monitoring using echocardiography measured GLS followed by initiation of cardioprotective therapy when there is a significant indication of heart injury prevents the reduction in heart function in those treated patients and reduces the risk of cardiotoxicity.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Since the primary outcome of the study which compared change in LVEF between the two arms regardless of whether cardioprotective therapy was initiated was negative, it would be important for future studies to use other more accurate techniques to measure heart function such as cardiac MRI to see if differences can be shown. Also studies that focus on cardiotoxicity or heart failure as the primary outcome are needed. However, this will require a study of 1000s of patients. Furthermore, it is important to study the use of this GLS based approach to prevent heart dysfunction in other patient population such as those with blood cancers who receive high doses of anthracyclines to treat their cancer.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study was only possible due to the generous effort of 28 centers internationally and the kindness of many patients. The study was co led by Dr. P. Thavendiranathan, Dr. Thomas Marwick, and Dr. Tomoko Negishi.
Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy
Paaladinesh Thavendiranathan, Tomoko Negishi, Emily Somerset, Kazuaki Negishi, Martin Penicka, Julie Lemieux, Svend Aakhus, Sakiko Miyazaki, Mitra Shirazi, Maurizio Galderisi, Thomas H. Marwick, and on behalf of the SUCCOUR Investigators
J Am Coll Cardiol. 2021 Feb, 77 (4) 392–401
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