Clinical Utility of Global Longitudinal Strain in Cancer Therapy Monitoring.

Abstract

Background: The 2022 European Society of Cardiology Cardio-Oncology guidelines recommend the use of global longitudinal strain (GLS) to detect mild asymptomatic cancer therapy related cardiac dysfunction (ma-CTRCD), a diagnosis similar to "subclinical dysfunction". However, it remains unknown how to best manage these patients in order to prevent clinically significant CTRCD. Aim(s): To assess the outcomes of cancer patients meeting criteria for ma-CTRCD. Method(s): Echocardiograms and medical records were assessed for patients receiving trastuzumab or anthracyclines, who underwent serial echocardiographic monitoring, including routine GLS. CTRCD was defined as a decline in left ventricular ejection fraction (LVEF) of >10% to <50%. ma-CTRCD was defined as a relative decline in average GLS of >15%, in the absence of a concurrent significant LVEF decline. Normal was defined as no significant change in LVEF or GLS. Result(s): 878 echocardiograms from 258 patients were analysed. CTRCD occurred in 23 (9%) and ma-CTRCD in 63 (24%). A change in management occurred in eight ma-CTRCD patients (cancer therapy withheld/ceased in three and heart failure medication commenced in six). Only two ma-CTRCD patients subsequently developed CTRCD, and GLS improved in 74%. Compared to the normal group, at baseline the ma-CTRCD group had higher average GLS (-21.8 vs -19.4, p<0.0001) and less borderline/abnormal average GLS (>-18) (4% vs 27%, p<0.004). Conclusion(s): Declines in GLS are common and should be interpreted cautiously to avoid unnecessary cancer therapy cessation or heart failure medication. Patients with higher baseline GLS may be more prone to clinically insignificant declines in GLS.Copyright � 2024