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Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study
The load dependence of global longitudinal strain (GLS) means that changes in systolic blood pressure (BP) between visits may confound the diagnosis of cancer-treatment-related cardiac dysfunction (CTRCD). We sought to determine whether the estimation of myocardial work, which incorporates SBP, coul...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880507/ https://www.ncbi.nlm.nih.gov/pubmed/35207185 http://dx.doi.org/10.3390/jcm11040912 |
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author | Kosmala, Wojciech Negishi, Tomoko Thavendiranathan, Paaladinesh Penicka, Martin De Blois, Jonathan Murbræch, Klaus Miyazaki, Sakiko Shirazi, Mitra Santoro, Ciro Vinereanu, Dragos Cho, Goo-Yeong Hristova, Krassimira Popescu, Bogdan A. Kurosawa, Koji Izumo, Masaki Negishi, Kazuaki Przewlocka-Kosmala, Monika Marwick, Thomas H. |
author_facet | Kosmala, Wojciech Negishi, Tomoko Thavendiranathan, Paaladinesh Penicka, Martin De Blois, Jonathan Murbræch, Klaus Miyazaki, Sakiko Shirazi, Mitra Santoro, Ciro Vinereanu, Dragos Cho, Goo-Yeong Hristova, Krassimira Popescu, Bogdan A. Kurosawa, Koji Izumo, Masaki Negishi, Kazuaki Przewlocka-Kosmala, Monika Marwick, Thomas H. |
author_sort | Kosmala, Wojciech |
collection | PubMed |
description | The load dependence of global longitudinal strain (GLS) means that changes in systolic blood pressure (BP) between visits may confound the diagnosis of cancer-treatment-related cardiac dysfunction (CTRCD). We sought to determine whether the estimation of myocardial work, which incorporates SBP, could overcome this limitation. In this case–control study, 44 asymptomatic patients at risk of CTRCD underwent echocardiography at baseline and after oncologic treatment. CTRCD was defined on the basis of the change in the ejection fraction. Those with CTRCD were divided into subsets with and without a follow-up SBP increment >20 mmHg (CTRCD+BP+ and CTRCD+BP−), and matched with patients without CTRCD (CTRCD−BP+ and CTRCD−BP−). The work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were assessed in addition to the GLS. The largest increases in the GWI and GCW at follow-up were found in CTRCD−BP+ patients. The CTRCD+BP− patients demonstrated significantly larger decreases in GWI and GCW than their CTRCD+BP+ and CTRCD−BP− peers. ROC analysis for the discrimination of LV functional changes in response to increased afterload in the absence of cardiotoxicity revealed higher AUCs for GCW (AUC = 0.97) and GWI (AUC = 0.93) than GLS (AUC = 0.73), GWW (AUC = 0.51), or GWE (AUC = 0.63, all p-values < 0.001). GCW (OR: 1.021; 95% CI: 1.001–1.042; p < 0.04) was the only feature independently associated with CTRCD−BP+. Myocardial work is superior to GLS in the serial assessments in patients receiving cardiotoxic chemotherapy. The impairment of GLS in the presence of an increase in GWI and GCW indicates the impact of elevated afterload on LV performance in the absence of actual myocardial impairment. |
format | Online Article Text |
id | pubmed-8880507 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-88805072022-02-26 Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study Kosmala, Wojciech Negishi, Tomoko Thavendiranathan, Paaladinesh Penicka, Martin De Blois, Jonathan Murbræch, Klaus Miyazaki, Sakiko Shirazi, Mitra Santoro, Ciro Vinereanu, Dragos Cho, Goo-Yeong Hristova, Krassimira Popescu, Bogdan A. Kurosawa, Koji Izumo, Masaki Negishi, Kazuaki Przewlocka-Kosmala, Monika Marwick, Thomas H. J Clin Med Article The load dependence of global longitudinal strain (GLS) means that changes in systolic blood pressure (BP) between visits may confound the diagnosis of cancer-treatment-related cardiac dysfunction (CTRCD). We sought to determine whether the estimation of myocardial work, which incorporates SBP, could overcome this limitation. In this case–control study, 44 asymptomatic patients at risk of CTRCD underwent echocardiography at baseline and after oncologic treatment. CTRCD was defined on the basis of the change in the ejection fraction. Those with CTRCD were divided into subsets with and without a follow-up SBP increment >20 mmHg (CTRCD+BP+ and CTRCD+BP−), and matched with patients without CTRCD (CTRCD−BP+ and CTRCD−BP−). The work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were assessed in addition to the GLS. The largest increases in the GWI and GCW at follow-up were found in CTRCD−BP+ patients. The CTRCD+BP− patients demonstrated significantly larger decreases in GWI and GCW than their CTRCD+BP+ and CTRCD−BP− peers. ROC analysis for the discrimination of LV functional changes in response to increased afterload in the absence of cardiotoxicity revealed higher AUCs for GCW (AUC = 0.97) and GWI (AUC = 0.93) than GLS (AUC = 0.73), GWW (AUC = 0.51), or GWE (AUC = 0.63, all p-values < 0.001). GCW (OR: 1.021; 95% CI: 1.001–1.042; p < 0.04) was the only feature independently associated with CTRCD−BP+. Myocardial work is superior to GLS in the serial assessments in patients receiving cardiotoxic chemotherapy. The impairment of GLS in the presence of an increase in GWI and GCW indicates the impact of elevated afterload on LV performance in the absence of actual myocardial impairment. MDPI 2022-02-09 /pmc/articles/PMC8880507/ /pubmed/35207185 http://dx.doi.org/10.3390/jcm11040912 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kosmala, Wojciech Negishi, Tomoko Thavendiranathan, Paaladinesh Penicka, Martin De Blois, Jonathan Murbræch, Klaus Miyazaki, Sakiko Shirazi, Mitra Santoro, Ciro Vinereanu, Dragos Cho, Goo-Yeong Hristova, Krassimira Popescu, Bogdan A. Kurosawa, Koji Izumo, Masaki Negishi, Kazuaki Przewlocka-Kosmala, Monika Marwick, Thomas H. Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study |
title | Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study |
title_full | Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study |
title_fullStr | Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study |
title_full_unstemmed | Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study |
title_short | Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study |
title_sort | incremental value of myocardial work over global longitudinal strain in the surveillance for cancer-treatment-related cardiac dysfunction: a case–control study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880507/ https://www.ncbi.nlm.nih.gov/pubmed/35207185 http://dx.doi.org/10.3390/jcm11040912 |
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