TY - JOUR
T1 - Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy
T2 - 3-Year Results of the SUCCOUR Trial
AU - Negishi, Tomoko
AU - Thavendiranathan, Paaladinesh
AU - Penicka, Martin
AU - Lemieux, Julie
AU - Murbraech, Klaus
AU - Miyazaki, Sakiko
AU - Shirazi, Mitra
AU - Santoro, Ciro
AU - Cho, Goo Yeong
AU - Popescu, Bogdan A.
AU - Kosmala, Wojciech
AU - Costello, Ben
AU - la Gerche, Andre
AU - Mottram, Phil
AU - Thomas, Liza
AU - Seldrum, Stephanie
AU - Hristova, Krassimira
AU - Bansal, Manish
AU - Kurosawa, Koji
AU - Fukuda, Nobuaki
AU - Yamada, Hirotsugu
AU - Izumo, Masaki
AU - Tajiri, Kazuko
AU - Sinski, Maciej
AU - Vinereanu, Dragos
AU - Shkolnik, Evgeny
AU - Banchs, Jose
AU - Kutty, Shelby
AU - Negishi, Kazuaki
AU - Marwick, Thomas H.
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/3
Y1 - 2023/3
N2 - 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.
AB - 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.
KW - cancer therapy–related cardiac dysfunction
KW - cardioprotective therapy
KW - global longitudinal strain
KW - heart failure
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U2 - 10.1016/j.jcmg.2022.10.010
DO - 10.1016/j.jcmg.2022.10.010
M3 - Article
C2 - 36435732
AN - SCOPUS:85142488513
SN - 1936-878X
VL - 16
SP - 269
EP - 278
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3
ER -