Predictors of arrhythmia and adverse outcomes in cancer patients during antitumor treatment

Malignancies are one of the leading causes of death in the world. Cardiotoxicity, including high-grade heart rhythm disturbances (HRD), is the leading cause of death in patients not directly associated with malignancies. Objective. To determine the predictors of arrhythmias and adverse outcomes in patients with cancer during and after antitumor treatment. Materials and methods. A comparative retrospective and prospective non-randomized observational study was conducted. The sample included patients with cancer (n=101) aged 25 to 80 years, with a high and very high risk of cardiotoxicity. The test group included 49 cancer patients with HRDs; 35 of them were included retrospectively, after the onset of arrhythmias, and 14 patients with HRDs were identified during prospective observation. The control group consisted of 52 cancer patients without arrhythmias during the observation. All study participants underwent a physical examination, an electrocardiogram (ECG), an echocardiogram in two-dimensional (2D) and three-dimensional (3D) modes with the calculation of global longitudinal strain of the left ventricle (GLSLV) and left atrium (GLSLA), and 24-hour 12-channel ECG monitoring. In some patients (n=68), the biomarkers were measured: cardiac-specific troponin I (TnI), N-terminal Brain Natriuretic ProPeptide (N-t proBNP), soluble suppression of tumorigenicity 2 (sST2), and myeloperoxidase. A telephone survey was conducted 24 months after enrollment. Results. Reduction of GLSLA in 2D mode in the filling phase <24% and GLSLV in 3D mode <18%, as well as an increase in N-t proBNP>186.1 ng/L, according to the ROC analysis, had the best predictive ability regarding the development of HRDs. Male sex, the presence of atrial fibrillation, and the use of antimetabolites were the most significant prognostic factors for adverse outcomes. LA dysfunction has been observed to be a predictor of arrhythmias (increase in indexed left atrial volume ≥40 mL/m2). Some publications show a decrease in patient survival associated with the use of antimetabolites in the antitumor treatment regimen. Conclusion. In addition to the standard echocardiographic examination in patients with cancer, it is recommended to assess several indicators of myocardial strain (the global longitudinal strain of the left ventricle in 3D mode, the longitudinal strain of the left atrium in the filling phase) and the level of the N-t proBNP.