Simultaneous Left Ventricular Volume and Strain Changes During Chemotherapy Associate With 2-Year Postchemotherapy Measures of Left Ventricular Ejection Fraction

Abstract

Background Although changes in left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume, and global circumferential strain occur during cancer treatment, the relationship of these changes to the 2-year post-cancer-treatment measures of left ventricular ejection fraction (LVEF) are unknown. Methods and Results In a prospective, continuously recruited cohort of 95 patients scheduled to receive potentially cardiotoxic chemotherapy for breast cancer, lymphoma, or soft tissue sarcoma, measures of left ventricular end-diastolic volume, LVESV, global circumferential strain, and LVEF were acquired via cardiac magnetic resonance imaging before and then 3 and 24 months after initiating treatment by individuals blinded to all patient identifiers. Participants had an average age of 54±15 years; 68% were women, and 82% were of white race. LVEF declined from 62±7% to 58±9% over the 24 months (P<0.0001), with 42% of participants experiencing a >5% decline in LVEF at 24 months. Predictors of a 24-month >5% decline in LVEF included the following factors from baseline to 3 months into treatment: (1) >3-mL increases in LVESV (P=0.033), (2) >3-mL increases in LVESV or 10-mL declines in left ventricular end-diastolic volume with little change in LVESV (P=0.001), or (3) ≥10% deteriorations in global circumferential strain with little change in LVESV (P=0.036). Conclusion During receipt of potentially cardiotoxic chemotherapy, increases in LVESV, the absence of its deterioration during decreases of left ventricular end-diastolic volume, or the deterioration of global circumferential strain without a marked decrease in LVESV help identify those who will develop more permanent 2-year declines in LVEF.

Keywords: cardiotoxicity; chemotherapy; global circumferential strain; left ventricular ejection fraction.

Figure 1

Participant disposition at 24 months. Withdrawal from the study was recorded at either the 3‐month visit or the 24‐month visit. Lost to follow‐up includes 4 participants who would not return calls and 2 participants who did not come to their scheduled visit.

Figure 2

Mean 3‐month change in left ventricular end‐diastolic volume (LVEDV) and left ventricular end‐systolic volume (LVESV) by 24‐month left ventricular ejection fraction (LVEF) status among patients without a 3‐month >3‐mL increase in LVESV. There is a significant difference in short‐term LVESV drop but not short‐term LVEDV drop by long‐term LVEF drop status among patients without a short‐term >3‐mL increase in LVESV.

Figure 3

Twenty‐four–month left ventricular ejection fraction (LVEF) status by 3‐month change in left ventricular end‐systolic volume (LVESV). A higher percentage of participants experienced LVEF drops of >5% or to below 50% at 24 months among those with early increases in LVESV.

Figure 4

Predictors of left ventricular ejection fraction (LVEF) decline of >5% or to below 50% at 24 months. Forest plots graph the odds ratios for various factors, such as left ventricular end‐systolic volume (LVESV), left ventricular end‐diastolic volume (LVEDV), and global circumferential strain (GCS), that possibly predict LVEF decline at 24 months. All predictors measure changes from baseline to 3 months. Error bars represent 95% CIs.