Randomized Controlled Trial

. 2023 Mar;16(3):269-278.

doi: 10.1016/j.jcmg.2022.10.010. Epub 2022 Nov 16.

Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy: 3-Year Results of the SUCCOUR Trial

Tomoko Negishi¹, Paaladinesh Thavendiranathan², Martin Penicka³, Julie Lemieux⁴, Klaus Murbraech⁵, Sakiko Miyazaki⁶, Mitra Shirazi⁷, Ciro Santoro⁸, Goo-Yeong Cho⁹, Bogdan A Popescu¹⁰, Wojciech Kosmala¹¹, Ben Costello¹², Andre la Gerche¹³, Phil Mottram¹⁴, Liza Thomas¹⁵, Stephanie Seldrum¹⁶, Krassimira Hristova¹⁷, Manish Bansal¹⁸, Koji Kurosawa¹⁹, Nobuaki Fukuda²⁰, Hirotsugu Yamada²¹, Masaki Izumo²², Kazuko Tajiri²³, Maciej Sinski²⁴, Dragos Vinereanu²⁵, Evgeny Shkolnik²⁶, Jose Banchs²⁷, Shelby Kutty²⁸, Kazuaki Negishi¹, Thomas H Marwick²⁹

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Sydney Medical School Nepean, Charles Perkins Centre Nepean, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
² Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Canada.
³ Cardiovascular Center Aalst, Aalst, Belgium.
⁴ Centre des Maladies du Sein, Hôpital du Saint-Sacrement, Centre Hospitalier Universitaire de Québec and Université Laval Research Center and Faculty of Medicine, Laval University, Québec City, Québec, Canada.
⁵ Oslo University Hospital, Oslo, Norway.
⁶ Juntendo University Hospital, Tokyo, Japan.
⁷ Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁸ Federico II University of Naples, Naples, Italy.
⁹ Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁰ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
¹¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Cardiology Department, Wroclaw Medical University, Wroclaw, Poland; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
¹² Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia.
¹³ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia.
¹⁴ Monash Medical Center, Melbourne, Victoria, Australia.
¹⁵ Westmead Hospital, Sydney, New South Wales, Australia.
¹⁶ University Catholique de Louvain-Mont Godinne, Louvain, Belgium.
¹⁷ National Cardiovascular Hospital, Sofia, Bulgaria.
¹⁸ Medanta The Medicity, Gurugram, India.
¹⁹ Gunma University Hospital, Gunma, Japan.
²⁰ Takasaki General Medical Center, Gunma, Japan.
²¹ Tokushima University, Tokushima, Japan.
²² St Marianna University, Tokyo, Japan.
²³ Tsukuba University, Ibaraki, Japan.
²⁴ Medical University of Warsaw, Warsaw, Poland.
²⁵ Carol Davila University, Bucharest, Romania.
²⁶ Moscow State University of Medicine and Dentistry, Moscow, Russia.
²⁷ MD Anderson Cancer Hospital, Houston, Texas, USA.
²⁸ University of Nebraska, Lincoln, Nebraska, USA.
²⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. Electronic address: tom.marwick@bakeridi.edu.au.

PMID: 36435732
DOI: 10.1016/j.jcmg.2022.10.010

Free article

Randomized Controlled Trial

Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy: 3-Year Results of the SUCCOUR Trial

Tomoko Negishi et al. JACC Cardiovasc Imaging. 2023 Mar.

Free article

. 2023 Mar;16(3):269-278.

doi: 10.1016/j.jcmg.2022.10.010. Epub 2022 Nov 16.

Authors

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Sydney Medical School Nepean, Charles Perkins Centre Nepean, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
² Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Canada.
³ Cardiovascular Center Aalst, Aalst, Belgium.
⁴ Centre des Maladies du Sein, Hôpital du Saint-Sacrement, Centre Hospitalier Universitaire de Québec and Université Laval Research Center and Faculty of Medicine, Laval University, Québec City, Québec, Canada.
⁵ Oslo University Hospital, Oslo, Norway.
⁶ Juntendo University Hospital, Tokyo, Japan.
⁷ Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁸ Federico II University of Naples, Naples, Italy.
⁹ Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁰ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
¹¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Cardiology Department, Wroclaw Medical University, Wroclaw, Poland; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
¹² Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia.
¹³ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia.
¹⁴ Monash Medical Center, Melbourne, Victoria, Australia.
¹⁵ Westmead Hospital, Sydney, New South Wales, Australia.
¹⁶ University Catholique de Louvain-Mont Godinne, Louvain, Belgium.
¹⁷ National Cardiovascular Hospital, Sofia, Bulgaria.
¹⁸ Medanta The Medicity, Gurugram, India.
¹⁹ Gunma University Hospital, Gunma, Japan.
²⁰ Takasaki General Medical Center, Gunma, Japan.
²¹ Tokushima University, Tokushima, Japan.
²² St Marianna University, Tokyo, Japan.
²³ Tsukuba University, Ibaraki, Japan.
²⁴ Medical University of Warsaw, Warsaw, Poland.
²⁵ Carol Davila University, Bucharest, Romania.
²⁶ Moscow State University of Medicine and Dentistry, Moscow, Russia.
²⁷ MD Anderson Cancer Hospital, Houston, Texas, USA.
²⁸ University of Nebraska, Lincoln, Nebraska, USA.
²⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. Electronic address: tom.marwick@bakeridi.edu.au.

PMID: 36435732
DOI: 10.1016/j.jcmg.2022.10.010

Abstract

Background: Global longitudinal strain (GLS) can predict cancer therapeutics-related cardiac dysfunction and guide initiation of cardioprotection (CPT).

Objectives: In this study, the authors sought to determine whether echocardiography GLS-guided CPT provides less cardiac dysfunction in survivors of potentially cardiotoxic chemotherapy, compared with usual care at 3 years.

Methods: In this international multicenter prospective randomized controlled trial, patients were enrolled from 28 international sites. All patients treated with anthracyclines with another risk factor for heart failure were randomly allocated to GLS-guided (>12% relative reduction in GLS) or ejection fraction (EF)-guided (>10% absolute reduction of EF to <55%) CPT. The primary end point was the change in 3-dimensional (3D) EF (ΔEF) from baseline to 3 years.

Results: Among 331 patients enrolled, 255 (77%, age 54 ± 12 years, 95% women) completed 3-year follow-up (123 in the EF-guided group and 132 in the GLS-guided group). Most had breast cancer (n = 236; 93%), and anthracycline followed by trastuzumab was the most common chemotherapy regimen (84%). Although 67 (26%) had hypertension and 32 (13%) had diabetes mellitus, left ventricular function was normal at baseline (EF: 59% ± 6%, GLS: 20.7% ± 2.3%). CPT was administered in 18 patients (14.6%) in the EF-guided group and 41 (31%) in the GLS-guided group (P = 0.03). Most patients showed recovery in EF and GLS after chemotherapy; 3-year ΔEF was -0.03% ± 7.9% in the EF-guided group and -0.02% ± 6.5% in the GLS-guided (P = 0.99) group; respective 3-year EFs were 58% ± 6% and 59% ± 5% (P = 0.06). At 3 years, 17 patients (5%) had cancer therapeutics-related cardiac dysfunction (11 in the EF-guided group and 6 in the GLS guided group; P = 0.16); 1 patient in each group was admitted for heart failure.

Conclusions: Among patients taking potentially cardiotoxic chemotherapy for cancer, the 3-year data showed improvement of LV dysfunction compared with 1 year, with no difference in ΔEF between GLS- and EF-guided CPT. (Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes [SUCCOUR]; ACTRN12614000341628).

Keywords: cancer therapy–related cardiac dysfunction; cardioprotective therapy; global longitudinal strain; heart failure.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported in part by a project grant (1119955) from the National Health and Medical Research Council, Canberra, Australia, and an unrestricted grant from General Electric Healthcare, Horten, Norway. At the CHU de Québec site, the study was funded by the Fondation du CHU de Québec. Dr Marwick is supported by an investigator grant (2008129) from the National Health and Medical Research Council, Canberra, Australia. Dr Thavendiranathan is supported by a Canadian Institutes of Health Research New Investigator Award (147814), an Ontario Early Research Award, and a Canada Research Chair in Cardio-oncology. Dr K. Negishi is supported by a fellowship (award reference no. 101868) from the National Heart Foundation of Australia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

An Inconvenient Truth About the LVEF and Cardiac Monitoring in Oncology: Please Don't Shoot the Messenger!
Barac A, López-Fernández T. Barac A, et al. JACC Cardiovasc Imaging. 2023 Mar;16(3):279-281. doi: 10.1016/j.jcmg.2022.11.017. Epub 2023 Jan 11. JACC Cardiovasc Imaging. 2023. PMID: 36752437 No abstract available.
Ejection Fraction vs Global Longitudinal Strain to Monitor Chemotherapy Recipients: The Turtle and the Rabbit.
Anastasiou V, Papazoglou AS, Daios S, Moysidis DV. Anastasiou V, et al. JACC Cardiovasc Imaging. 2023 Sep;16(9):1242. doi: 10.1016/j.jcmg.2023.03.028. JACC Cardiovasc Imaging. 2023. PMID: 37673482 No abstract available.
Reply: Ejection Fraction vs Global Longitudinal Strain to Monitor Chemotherapy Recipients: The Turtle and the Rabbit.
Marwick TH, Negishi T, Thavendiranathan P; SUCCOUR investigators. Marwick TH, et al. JACC Cardiovasc Imaging. 2023 Sep;16(9):1243. doi: 10.1016/j.jcmg.2023.06.016. JACC Cardiovasc Imaging. 2023. PMID: 37673483 No abstract available.

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Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy: 3-Year Results of the SUCCOUR Trial

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Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy: 3-Year Results of the SUCCOUR Trial

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