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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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| Institution: | 1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia;2. Sydney Medical School Nepean, Charles Perkins Centre Nepean, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia;3. Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Canada;4. Cardiovascular Center Aalst, Aalst, Belgium;5. 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;6. Oslo University Hospital, Oslo, Norway;7. Juntendo University Hospital, Tokyo, Japan;8. Royal Adelaide Hospital, Adelaide, South Australia, Australia;9. Federico II University of Naples, Naples, Italy;10. Seoul National University Bundang Hospital, Seongnam, Korea;11. University of Medicine and Pharmacy Carol Davila, Bucharest, Romania;12. Cardiology Department, Wroclaw Medical University, Wroclaw, Poland;13. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia;14. Alfred Hospital, Melbourne, Victoria, Australia;15. St Vincent’s Hospital, Melbourne, Victoria, Australia;p. Monash Medical Center, Melbourne, Victoria, Australia;q. Westmead Hospital, Sydney, New South Wales, Australia;r. University Catholique de Louvain–Mont Godinne, Louvain, Belgium;s. National Cardiovascular Hospital, Sofia, Bulgaria;t. Medanta The Medicity, Gurugram, India;u. Gunma University Hospital, Gunma, Japan;v. Takasaki General Medical Center, Gunma, Japan;w. Tokushima University, Tokushima, Japan;x. St Marianna University, Tokyo, Japan;y. Tsukuba University, Ibaraki, Japan;z. Medical University of Warsaw, Warsaw, Poland;11. Carol Davila University, Bucharest, Romania;22. Moscow State University of Medicine and Dentistry, Moscow, Russia;33. MD Anderson Cancer Hospital, Houston, Texas, USA;44. University of Nebraska, Lincoln, Nebraska, USA |
| Abstract: | BackgroundGlobal longitudinal strain (GLS) can predict cancer therapeutics–related cardiac dysfunction and guide initiation of cardioprotection (CPT).ObjectivesIn 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.MethodsIn 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.ResultsAmong 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.ConclusionsAmong 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 ACEI"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"angiotensin-converting enzyme inhibitor ARB"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"angiotensin receptor blocker CPT"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"cardioprotective therapy CTRCD"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"cancer therapy–related cardiac dysfunction EF"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"ejection fraction GLS"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"global longitudinal strain HF"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"heart failure LV"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"left ventricular LVEF"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"left ventricular ejection fraction |
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