Strain-derived myocardial work indices in adult cancer survivors: results from an observational study and comparison with available reference ranges.

Abstract

Aims: Adult survivors of haematological malignancies are at increased risk of long-term cardiovascular sequelae. Several echocardiographic metrics have been tested to detect subclinical myocardial dysfunction before it progresses toward cardiac events. Myocardial work (MW) is a load-independent echocardiographic index that conjugates non-invasive arterial blood pressure and global longitudinal strain (GLS).

Methods: Sixty-three disease-free survivors of Hodgkin Lymphoma (HL) [49% male, median age 42 (33,0-50,5) years], without known cardiovascular disease or reported cardiological symptoms, were included in this observational study. Myocardial work data from cancer survivors were compared with those from healthy subjects recruited in the EACVI NORRE Study.

Results: Mean left ventricular ejection fraction and GLS were, respectively, 57,0% (55,0-60,0) and - 18,0% (-19,2-17,1). Global work efficiency [GWE, 96% (94-97)], global work index (GWI, 1732 ± 340 mmHg%) and global wasted work [GWW, 78 (55-131) mmHg%] did not differ between male and female survivors; however, global constructive work (GCW, 2116 ± 386 mmHg%) was lower in males. Of importance, GWI and GCW were lower in cancer survivors compared to healthy subjects from the EACVI NORRE study (p = 0,0008 and p = 0,0324, respectively). When evaluating associations of MW indices with patients' characteristics, only systolic blood pressure and ejection fraction were independently associated with both GWI and GCW at multivariable analysis.

Conclusion: For the first time, this report provides values of MW indices in asymptomatic HL survivors without cardiovascular disease. GWI and GCW were significantly lower in HL survivors compared to healthy subjects. MW metrics might serve as valuable markers of subclinical cardiac dysfunction in this population.