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. 2017 May 15;119(10):1637-1642.
doi: 10.1016/j.amjcard.2017.02.008. Epub 2017 Mar 22.

Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment

Giselle C Meléndez  1 , Bunyapon Sukpraphrute  2 , Ralph B D'Agostino Jr  3 , Jennifer H Jordan  2 , Heidi D Klepin  4 , Leslie Ellis  4 , Zanetta Lamar  4 , Sujethra Vasu  2 , Glenn Lesser  4 , Gregory L Burke  5 , Kathryn E Weaver  5 , William O Ntim  2 , W Gregory Hundley  6
Affiliations

Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment

Giselle C Meléndez et al. Am J Cardiol. .

Abstract

We sought to determine the frequency by which decreases in left ventricular (LV) end-diastolic volume (LVEDV) with and without increases in end-systolic volume (LVESV) influenced early cancer treatment-associated declines in LV ejection fraction (LVEF) or LV mass. One hundred twelve consecutively recruited subjects (aged 52 ± 14 years) with cancer underwent blinded cardiovascular magnetic resonance measurements of LV volumes, mass, and LVEF before and 3 months after initiating potentially cardiotoxic chemotherapy (72% of participants received anthracyclines). Twenty-six participants developed important declines in LVEF of >10% or to values <50% at 3 months, in whom 19% versus 60%, respectively, experienced their decline in LVEF due to isolated declines in LVEDV versus an increase in LVESV; participants who dropped their LVEF due to decreases in LVEDV lost more LV mass than those who dropped their LVEF due to an increase in LVESV (p = 0.03). Nearly one fifth of subjects experience marked LVEF declines due to an isolated decline in LVEDV after initiating potentially cardiotoxic chemotherapy. Because reductions in intravascular volume (which could be treated by volume repletion) may account for LVEDV-related declines in LVEF, these data indicate that LV volumes should be reviewed along with LVEF when acquiring imaging studies for cardiotoxicity during the treatment for cancer.

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Conflict of interest statement

Disclosures: Conflicts of interest: none. All authors have approved the final article.

Figures

Figure 1
Figure 1. Determinants of declines in left ventricular ejection fraction during receipt of potentially cardiotoxic chemotherapy
As shown, the left ventricular ejection fraction (LVEF) is calculated by subtracting the end-systolic volume (LVESV) from the end-diastolic volume (LVEDV) and dividing by the original LVEDV. During cancer treatment, there are two mechanisms by which LVEF could decline: 1) the LVEDV could decline (diminished left ventricular preload) and result in a decreased in LVEF (white box). In cancer patients, this may occur due to decreased PO intake, vomiting, or diarrhea; 2) alternatively, the LVEF can also decline if the LVESV increases. This situation occurs when there is diminished left ventricular contractility (black boxes). In patients receiving cancer treatment, this could be due to the adverse consequences of chemotherapy, sepsis, or underlying ischemic heart disease.
Figure 2
Figure 2. Individuals that experience cancer therapeutics-related cardiac dysfunction (CTRCD) defined as LVEF drops of >10% or a decline to an absolute value of <50%, 3 months after initiating potentially cardiotoxic chemotherapy
Participants who experienced CTRCD due to isolated LVEDV declines are shown in the white box; those who experience increases in LVESV with minimal changes to LVEDV (impaired LV contractility) are shown in the black box; participants who had a combination of LVEDV drop and LVESV increase are shown in white and black box and those with minor LVEDV and LVESV changes are shown in the gray box.
Figure 3
Figure 3. Individuals that did not experience LVEF changes or that LVEF drops did not meet cancer therapeutics-related cardiac dysfunction (CTRCD) criteria (LVEF drops of >10% or a decline to an absolute value of <50%) 3 months after initiating potentially cardiotoxic chemotherapy
Participants who experienced isolated LVEDV declines are shown in the white box; those who experience increases in LVESV with minimal changes to LVEDV (impaired LV contractility) are shown in the black box; participants who had a combination of LVEDV drop and LVESV increase are shown in the white and black box and those with minor LVEDV and LVESV changes are shown in the gray box.
Figure 4
Figure 4
a-Left ventricular (LV) mass changes among individuals with (dotted line) and without (solid line) cancer therapeutics-related cardiac dysfunction (CTRCD) and b- LV mass changes among participants with CTRCD due to decreases in LV end diastolic volume (EDV, solid line) and increases in LV end systolic volume (ESV, dotted line).
Figure 5
Figure 5
Mean cumulative doses of anthracyclines administered to participants with and without CTRCD due to LVEDV decline (white bars) and LVESV increase (black bars).
See this image and copyright information in PMC

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