Incremental prognostic value of echocardiographic strain and its association with mortality in cancer patients

Isaac B. Rhea, Sarada Uppuluri, Stephen Sawada, Bryan Schneider, Harvey Feigenbaum

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33 Citations (Scopus)

Abstract

Background Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. Methods In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. Results Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P <.10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54-2.92; P <.001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14-3.27; P =.014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81-0.97; P =.012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ<sup>2</sup> value after adding GLS (P =.011) to significant clinical variables. Conclusions Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.

Original languageEnglish
Pages (from-to)667-673
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume28
Issue number6
DOIs
StatePublished - Jun 1 2015

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Mortality
Neoplasms
Drug Therapy
Heart Ventricles
Fatigue
Echocardiography
Cardiovascular Diseases
Heart Failure
Retrospective Studies

Keywords

  • Echocardiography
  • Mortality
  • Neoplasia
  • Prognosis
  • Speckle-tracking imaging
  • Strain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{269068b751354dd3986a9d5aef289497,
title = "Incremental prognostic value of echocardiographic strain and its association with mortality in cancer patients",
abstract = "Background Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. Methods In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50{\%}) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. Results Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P <.10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95{\%} confidence interval, 1.54-2.92; P <.001), male sex (hazard ratio, 1.93; 95{\%} confidence interval, 1.14-3.27; P =.014), and GLS (hazard ratio, 0.89; 95{\%} confidence interval, 0.81-0.97; P =.012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ2 value after adding GLS (P =.011) to significant clinical variables. Conclusions Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.",
keywords = "Echocardiography, Mortality, Neoplasia, Prognosis, Speckle-tracking imaging, Strain",
author = "Rhea, {Isaac B.} and Sarada Uppuluri and Stephen Sawada and Bryan Schneider and Harvey Feigenbaum",
year = "2015",
month = "6",
day = "1",
doi = "10.1016/j.echo.2015.02.006",
language = "English",
volume = "28",
pages = "667--673",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
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TY - JOUR

T1 - Incremental prognostic value of echocardiographic strain and its association with mortality in cancer patients

AU - Rhea, Isaac B.

AU - Uppuluri, Sarada

AU - Sawada, Stephen

AU - Schneider, Bryan

AU - Feigenbaum, Harvey

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. Methods In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. Results Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P <.10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54-2.92; P <.001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14-3.27; P =.014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81-0.97; P =.012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ2 value after adding GLS (P =.011) to significant clinical variables. Conclusions Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.

AB - Background Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. Methods In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. Results Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P <.10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54-2.92; P <.001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14-3.27; P =.014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81-0.97; P =.012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ2 value after adding GLS (P =.011) to significant clinical variables. Conclusions Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.

KW - Echocardiography

KW - Mortality

KW - Neoplasia

KW - Prognosis

KW - Speckle-tracking imaging

KW - Strain

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U2 - 10.1016/j.echo.2015.02.006

DO - 10.1016/j.echo.2015.02.006

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JO - Journal of the American Society of Echocardiography

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