Abstract
Background
We sought to investigate left ventricular (LV) function and mechanics in patients
with cancer before they received chemotherapy or radiotherapy, as well as the relationship
between cancer and reduced LV multidirectional strain in the whole study population.
Methods
The retrospective study involved 122 chemotherapy- and radiotherapy-naive patients
with cancer and 45 age- and sex-matched controls with a cardiovascular risk profile
similar to that of the patients with cancer. All the patients underwent echocardiographic
examination before introduction of chemotherapy or radiotherapy.
Results
LV longitudinal (−19.1% ± 2.1% vs −17.8% ± 3.5%; P = 0.022), circumferential (−22.9% ± 3.5% vs −20.1% ± 4.1%; P < 0.001), and radial (40.5% ± 8.8% vs 35.2% ± 10.7%; P = 0.004) strain was significantly lower in the patients with cancer than in the control
group. Endocardial and midmyocardial longitudinal LV strain was significantly reduced
in the patients with cancer compared with the controls, whereas epicardial longitudinal
strain was similar between these groups. Endocardial, midmyocardial, and epicardial
circumferential strain was significantly lower in the chemotherapy- or radiotherapy-naive
patients with cancer than in the controls. Cancer was associated with reduced longitudinal
(odds ratio [OR], 9.0; 95% confidence interval [CI], 2.20-23.50; P < 0.001), reduced circumferential (OR, 7.1; 95% CI, 3.80-20.40; P < 0.001), and reduced radial strain (OR, 7.2; 95% CI, 3.41-25.10; P < 0.001) independent of age, sex, body mass index, diabetes, and hypertension.
Conclusions
LV mechanics was impaired in the patients with cancer compared with the controls even
before initiation of chemotherapy and radiotherapy. Cancer and hypertension were associated
with reduced LV multidirectional strain independent of other clinical parameters.
The present results indicate that cancer itself potentially induces cardiac remodelling
independent of chemotherapy and radiotherapy.
Résumé
Contexte
Nous souhaitions étudier l’activité et la fonction ventriculaire gauche chez des patients
atteints d’un cancer avant qu’ils reçoivent une chimiothérapie ou une radiothérapie,
ainsi que le lien entre le cancer et la réduction de la surcharge ventriculaire gauche
multidirectionnelle dans l’ensemble de la population de l’étude.
Méthodologie
L’étude rétrospective a porté sur 122 patients atteints de cancer n’ayant jamais été
traités par chimiothérapie ni radiothérapie et 45 patients témoins d’âge et de sexe
appariés présentant un profil de risque cardiovasculaire comparable à celui des patients
cancéreux. Tous les patients se sont soumis à un échocardiogramme avant l’instauration
de la chimiothérapie ou de la radiothérapie.
Résultats
La surcharge ventriculaire gauche longitudinale (-19,1 % ± 2,1 % vs -17,8 % ± 3,5
%; p = 0,022), circonférentielle (-22,9 % ± 3,5 % vs -20,1 % ± 4,1 %; p < 0,001) et radiale (40,5 % ± 8,8 % vs 35,2 % ± 10,7 %; p = 0,004) était considérablement plus basse chez les patients atteints de cancer que
chez ceux du groupe témoin. La surcharge ventriculaire gauche longitudinale endocardique
et mid-myocardique était considérablement réduite chez les patients atteints de cancer
comparativement aux patients du groupe témoin, alors que la surcharge longitudinale
épicardique était similaire entre ces deux groupes. La surcharge circonférentielle
endocardique, mid-myocardique et épicardique était considérablement plus basse chez
les patients atteints de cancer n’ayant jamais reçu de chimiothérapie ni de radiothérapie
par rapport aux patients du groupe témoin. Le cancer a été associé à une réduction
de la surcharge longitudinale (rapport de cotes [RC], 9,0; intervalle de confiance
[IC] à 95 %, 2,20 à 23,50; p < 0,001), à une réduction de la surcharge circonférentielle (RC, 7,1; IC à 95 %,
3,80 à 20,40; p < 0,001) et à une réduction de la surcharge radiale (RC, 7,2; IC à 95 %, 3,41 à 25,10;
p < 0,001) indépendamment de l’âge, du sexe, de l’indice de masse corporelle, de la
présence de diabète et de la présence d’hypertension.
Conclusions
La fonction ventriculaire gauche était compromise chez les patients atteints de cancer
comparativement aux patients du groupe témoin même avant l’instauration d’une chimiothérapie
et d’une radiothérapie. Le cancer et l’hypertension ont été associés à une réduction
de la surcharge ventriculaire gauche multidirectionnelle indépendamment des autres
paramètres cliniques. Les présents résultats indiquent que le cancer lui-même peut
induire un remodelage cardiaque indépendamment de la chimiothérapie et de la radiothérapie.
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Article info
Publication history
Published online: November 29, 2017
Accepted:
November 26,
2017
Received:
October 6,
2017
Footnotes
See editorial by Kirkham et al., pages 234–235 of this issue.
See page 286 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Does Cancer Affect Cardiac Function Prior to Cancer Therapy Exposure?Canadian Journal of CardiologyVol. 34Issue 3
- PreviewCancer therapy–related cardiac dysfunction is a potential side effect of many cancer treatments, including anthracycline chemotherapy, targeted therapies, and chest radiotherapy, as well as many antineoplastic drugs in development.1 Ten years ago, the multiple-hit hypothesis was proposed, suggesting that pre-existing risk factors coupled with direct and indirect (through associated deconditioning) effects of cancer therapies on the cardiovascular system jointly conspire to increase the risk of heart failure in breast cancer survivors.
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