Providers must rethink traditional imaging approaches to prevent cardiotoxicity in cancer patients
Imaging-based global longitudinal strain measurements can help identify cancer patients with cardiovascular issues who may be in danger of sustaining heart damage from chemotherapy, according to results of a new multicenter clinical trial.
Some cancer treatments, such as anthracycline-based chemotherapy, effectively attack the disease but also cause heart damage—a condition known as cardiotoxicity. Traditionally, providers use echocardiography to measure how much blood is pumped out of the left ventricle of the heart with each contraction, known as left ventricular ejection fraction, to monitor patients’ cardiac function during treatment.
Authors of this study in the February issue of JACC, however, tested whether global longitudinal strain—a measurement known to better identify heart damage—could outperform LVEF and help spot high-risk patients sooner.
“We hoped our study would show a better way to care for cancer patients, who are already fighting one disease and should not have to worry about the future risk of heart failure too,” first author Dinesh Thavendiranathan, MD, head of Toronto General Hospital’s cardiotoxicity prevention program, said in a statement.
To do this, they randomized 331 patients into two groups: one received echocardiography exams to measure LVEF and the other underwent this current standard of care along with imaging to measure global longitudinal strain. The latter measures heart muscle deformation.
While the controlled trial didn’t meet its primary endpoint, it did show that monitoring GLS helped initiate treatment in patients with heart function abnormalities. Those monitored using GLS experienced fewer changes in cardio function and a lower risk of cardiotoxicity, the authors explained. Furthermore, heart damage was detected earlier using this new approach and in twice the number of patients.
“The purpose of a sensitive method like GLS is to pick up the presence of disease and treat it early,” Thavendiranathan added. “This means more patients will be treated, and if we start heart medications when a change is identified, we can prevent significant worsening of heart function.”
All in all, the researchers said providers should consider changing how they monitor patients during cancer therapy and add GLS to routine surveillance.
Read the full study published in the Journal of the American College of Cardiology here.
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Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.