Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics-Related Cardiac Dysfunction

Hari K. Narayan, Benjamin French, Abigail Khan, Theodore Plappert, David Hyman, Akinyemi Bajulaiye, Susan Domchek, Angela DeMichele, Amy Clark, Jennifer Matro, Angela Bradbury, Kevin Fox, Joseph R. Carver, Bonnie Ky

Research output: Contribution to journalArticle

39 Scopus citations

Abstract

Objectives: This study sought to determine the relationships between echocardiography-derived measures of myocardial mechanics and cancer therapeutics-related cardiac dysfunction (CTRCD). Background: Doxorubicin and trastuzumab are highly effective breast cancer therapies, but have a substantial risk of CTRCD. There is a critical need for the early detection of patients at increased risk of toxicity. Methods: We performed a prospective, longitudinal cohort study of breast cancer participants undergoing doxorubicin and/or trastuzumab therapy. Echocardiography was performed prior to therapy initiation (baseline) and at standardized follow-up intervals during and after completion of therapy. Ejection fraction (EF), strain, strain rate, and ventricular-arterial coupling (effective arterial elastance [Ea]/end-systolic elastance [Eessb]) were quantitated. CTRCD was defined as a ≥10% reduction in EF from baseline to sb, circumferential strain, and circumferential strain rate were associated with 21% to 38% increased odds of CTRCD (p <0.001). Changes in longitudinal strain (p = 0.037), radial strain (p = 0.015), and radial strain rate (p = 0.006) were also associated with CTRCD. Ea/Eessb (area under the curve: 0.703; 95% confidence interval: 0.583 to 0.807) and circumferential strain (area under the curve: 0.655; 95% confidence interval: 0.517 to 0.767) demonstrated the greatest predictive utility. Sensitivity analyses using an alternative CTRCD definition did not impact our results. Conclusions: Over an extended follow-up time, ventricular-arterial coupling and circumferential strain were strongly predictive of CTRCD. Our findings suggest a noninvasive strategy to identify high-risk patients prior to, during, and after cardiotoxic cancer therapy.

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
DOIs
StateAccepted/In press - Aug 12 2015
Externally publishedYes

Keywords

  • Cardio-oncology
  • Echocardiography
  • Mechanics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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    Narayan, H. K., French, B., Khan, A., Plappert, T., Hyman, D., Bajulaiye, A., Domchek, S., DeMichele, A., Clark, A., Matro, J., Bradbury, A., Fox, K., Carver, J. R., & Ky, B. (Accepted/In press). Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics-Related Cardiac Dysfunction. JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2015.11.024