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. 2022 Aug;18(24):2675-2685.
doi: 10.2217/fon-2022-0116. Epub 2022 Jul 7.

Detecting subclinical anthracycline therapy-related cardiac dysfunction in patients attending Uganda Cancer Institute

Wanzhu Zhang  1   2   3 , Feriel Azibani  4 , Elena Libhaber  1   5 , Emmy Okello  2   3 , James Kayima  2   3 , Isaac Ssinabulya  2   3 , Joseph Leeta  6 , Jackson Orem  3   6 , Karen Sliwa  1
Affiliations

Detecting subclinical anthracycline therapy-related cardiac dysfunction in patients attending Uganda Cancer Institute

Wanzhu Zhang et al. Future Oncol. 2022 Aug.

Abstract

Aims: To investigate the incidence of anthracycline therapy-related cardiac dysfunction (ATRCD) and its predictors among Ugandan cancer patients. Patients & methods: The study recruited 207 cancer patients who were followed for 6 months after ending anthracycline therapy. Global longitudinal strain and troponin-I were the diagnostic tools. Results & conclusions: The cumulative incidences of subclinical and clinical ATRCD were 35.0 and 8.8% respectively. The predictors of clinical ATRCD were HIV infection (hazard ratio [HR]: 3.04; 95% CI: 1.26-7.32; p = 0.013), lower baseline global longitudinal strain (HR: 0.61; 95% CI: 0.53-0.71; p < 0.001) and development of subclinical ATRCD at the end of anthracycline therapy (HR: 6.61; 95% CI: 2.60-16.82; p < 0.001). Cardiac surveillance at baseline and at ending of anthracycline therapy is essential to identify high-risk patients.

Keywords: clinical anthracycline-related cardiac dysfunction; incidence; predictor; subclinical anthracycline therapy-related cardiac dysfunction.

Plain language summary

Anthracyclines are drugs for treating many types of cancers. They may however be harmful to the heart. This anthracycline side effect will first cause subtle heart–cell injury that can be detected and treated if it is handled early. Therefore, this study aims to study patients in the Uganda Cancer Institute to find out how many patients can get and who are likely to get this side effect. We found that 35% of the patients had subtle heart–cell injury and 8.8% had a more severe form of heart–cell injury. The patients who lived with HIV, whose heart was weaker and who got subtle heart–cell injury immediately after treatment were more likely to get the severe form of the side effect. Patients who receive anthracycline therapy need to be monitored closely to prevent serious heart injury.

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Figures

Figure 1.
Figure 1.. Patient flow chart.
Between November 2018 and April 2021, 355 patients were recruited at the baseline (prechemotherapy). There were 207 patients who completed anthracycline therapy and returned for the second visit at the end of the anthracycline therapy. Among them, 145 patients came back for the third visit after 6 months, 27 patients died, 17 patients were last known alive and 19 patients were considered as lost to follow-up. Chemo: Chemotherapy; ECHO: Echocardiography; LV: Left ventricle; LBBB: Left bundle branch block.
Figure 2.
Figure 2.. Outcome at 6 months after the end of anthracycline therapy for patients who were diagnosed with subclinical anthracycline therapy-related cardiac dysfunction.
Among the 52 the patients who were diagnosed with subclinical ATRCD at the second follow-up visit (end of the anthracycline therapy), 43 patients were able to come back for the third follow-up visit (6 months after ending anthracycline therapy). At the third follow-up visit, 14/43 (32.6%) patients had full recovery of the global longitudinal strain and/or troponin-I, 25/43 (58.1%) patients still had subclinical ATRCD and 4/43 (9.3%) patients progressed to clinical ATRCD. ATRCD: Anthracycline therapy-related cardiac dysfunction.
See this image and copyright information in PMC

References

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