New opportunities for preclinical diagnostics of antitumor therapy cardiotoxicity: results of an observational study

Aim. To study new possibilities of the potential of speckle tracking echocardiography for detecting early subclinical cardiotoxicity of chemo- and targeted therapy. Material and methods. 150 patients with a verified oncological diagnosis, with a very high or high risk of cardiotoxicity, determined by the Mayo Clinic scale, were included in the prospective observational study at the Department of Hospital Therapy No. 1 of the Russian Medical University of the Ministry of Health of Russia in 2021-2023. All enrolled patients were recommended to take a fixed combination of the ACE inhibitor perindopril and the beta-blocker bisoprolol (5+5 mg) 5-7 days before the start of chemo-targeted therapy. Patients with a very high risk of cardiotoxicity who were diagnosed with ischemic chronic heart failure or stable coronary artery disease, or post-myocardial infarction, were additionally recommended to take long-acting trimetazidine OD at a dose of 80 mg once daily. At the second visit, the main group (n=84, receiving cardioprotective drugs) and the comparison group (n=66, not receiving cardioprotective drugs) were formed. All patients at the time of inclusion in the study, as well as 1, 3, 6, 9 and 12 months after the start of antitumor therapy, underwent the following assessment: collecting complaints, anamnesis data, physical examination, ECG registration in 12 standard leads, and a two-dimensional echocardiogram with the measurement of left ventricular (LV) global longitudinal strain (GLS). Results. Primary drug prophylaxis in cancer patients with high and very high risk of cardiotoxicity was associated with a 2.7-fold decrease in significant cardiovascular complications. The development of chronic heart failure in the main group was noted 7 times less frequently than in the comparison group (n=1 (1.2%) vs n=7 (10.6%), p<0.05), a decrease in GLS LV 2.6 times (n=5 (5.9%) vs n=13 (19.7%), p<0.05). During the observation of oncological patients receiving chemo- and targeted therapy, it was found that a specific pattern, previously not described, was revealed in patients with developed systolic dysfunction upon visual assessment of the longitudinal strain of the LV. A decrease in contractility was noted in all LV basal segments, visually displayed by a pale or even blue color along the circumference of the diagram, with the presence of compensatory hyperkinesia of LV apical segments. LV strain reduction in the basal segments along the circumference of the outer part of the polar diagram >-18%, compensatory hyperkinesia of LV apical segments contractility <-18% in the inner part of the diagram compared to the initially determined values of the LV longitudinal strain before the start of antitumor therapy is an early, preclinical sign of cardiotoxicity. Conclusion. The detection of typical changes in local longitudinal strain should be considered as an early sign of cardiotoxicity with a subsequent change in treatment tactics: temporary or permanent withdrawal of the drugs that caused cardiovascular complications, the appointment of cardioprotective therapy with ACE inhibitors, beta-adrenergic blockers and myocardial cytoprotectors.