Left ventricular diastolic dysfunction in lung carcinoma patients: pilot study
M Viduljevic, M Polovina, M Tomic, A Stojicevic, J Pajkanovic, N Boskovic, M AsaninAbstract
Background
Lung carcinoma patients are continuously exposed to hypoxia, systemic inflammation, coagulation system abnormalities, all of which may adversely affect myocardial structure and function. Beside systemic effects from primary disease, oncologic therapies may further contribute to cardiac involvement. However, data on the prevalence and characteristics of subclinical myocardial functional and structural abnormalities in this patient population remain limited, particularly in real-world settings.
Purpose
To explore the prevalence and clinical correlates of subclinical cardiac dysfunction, with a particular focus on diastolic dysfunction, in patients with lung carcinoma.
Methods
This prospective, single-centre, exploratory (pilot) observational study included patients with a confirmed diagnosis of lung carcinoma admitted to a tertiary care centre. All patients underwent comprehensive cardiologic assessment, including physical examination, laboratory testing, electrocardiography, and transthoracic echocardiography. The primary outcome was the detection of subclinical myocardial dysfunction, defined by structural or functional echocardiographic abnormalities in the absence of overt heart failure. Patients were stratified and compared according to the presence of left ventricular diastolic dysfunction. Diastolic dysfunction was defined by the presence of >2 abnormal criteria: average E/e′ >14, septal e′ <7 cm/s or lateral e′ <10 cm/s, left atrial volume index >34 mL/m² and peak tricuspid regurgitation velocity >2.8 m/s.
Results
Diastolic dysfunction was identified in 45.5% of patients, predominantly among male individuals. Patients with diastolic dysfunction were more frequently treated with immunotherapy compared with those without diastolic dysfunction (77.8% vs. 22.2%, p<0.05). Patients treated with immunotherapy demonstrated higher odds of having diastolic dysfunction (OR 8.08, 95% CI 1.26-51.84, p=0.028), after adjustment for age and sex. No significant differences were observed between groups with respect to cardiac biomarkers (BNP, high-sensitivity troponin T), right ventricular parameters (basal diameter, right ventricular systolic pressure, TAPSE), or prior cardiovascular events. Although advanced-stage lung carcinoma (stage III–IV) was more prevalent among patients with diastolic dysfunction, this difference did not reach statistical significance.
Conclusion
In this pilot, hypothesis-generating study, subclinical diastolic dysfunction was frequently observed in patients with lung carcinoma despite preserved left ventricular systolic function, suggesting a high burden of occult myocardial involvement. The observed association with immunotherapy may represent an early signal of treatment-related cardiac effects and warrants further investigation in larger, dedicated cardio-oncology cohorts. Routine echocardiographic surveillance may facilitate early detection of subclinical myocardial dysfunction in this population.For image description, please refer to the figure legend and surrounding text.