Reversibility of subclinical left ventricular dysfunction detected by global longitudinal strain during cancer therapy

Introduction

A reduction in global longitudinal strain (GLS) is an early marker of cancer therapy–related cardiac dysfunction, often preceding LVEF decline. GLS impairment with preserved LVEF is considered subclinical myocardial dysfunction, though management remains unclear. This study evaluated cardiovascular and oncological features and the effect of cardioprotective therapy in patients with subclinical dysfunction during active cancer treatment.

Methods

We retrospectively analysed consecutive patients without prior cardiovascular disease who were referred from oncology to the heart failure (HF) unit after subclinical cardiac dysfunction was detected on transthoracic echocardiography during active cancer treatment. Subclinical dysfunction was defined as GLS < –17% with preserved LVEF (>50%) using speckle-tracking. Patients were followed until GLS normalization (> –17%), with cardioprotective therapy progressively introduced and titrated to achieve GLS normalization at the treating cardiologist’s discretion. Paired comparisons between baseline and last follow-up were performed using Student’s t test or Wilcoxon test, as appropriate.

Results

Twenty-four patients were included, with an age of 69.5 years (IQR 58.2–79); 62.5% were women. Cardiovascular risk factors were common, including hypertension (41.7%), dyslipidaemia (58.3%), and diabetes (25%). Breast cancer was the most frequent malignancy (41.6%), followed by haematological cancers (25%). Most patients received chemotherapy alone or combined with targeted therapy; taxanes (45.8%) and anthracyclines (33.3%) were the most frequently used agents, while trastuzumab was administered in 29.1% of cases.

Over a median follow-up of 4.5 months (IQR 1.2–12.7), cardioprotective therapy was sequentially optimized. Beta-blockers were used in 91.6% of patients, RAAS inhibitors in 75%, SGLT2 inhibitors in 75%, and MRAs increased from 8.3% to 45.8%. Significant improvements were observed in GLS (–15.6% to –20.0%; p<0.05), and NT-proBNP levels (p<0.05). Heart rate and diastolic blood pressure decreased significantly, while a mild but significant decline in renal function was observed (table 1). During follow-up, one hospitalization for HF occurred, and one patient died from non-cardiovascular, non-oncological causes. No changes in oncological treatment were required.

Conclusions

In patients receiving active potentially cardiotoxic cancer therapy, early identification of subclinical myocardial dysfunction using GLS allowed timely initiation and optimization of cardioprotective therapy. This strategy was associated with significant improvement in myocardial deformation and reduction in NT-proBNP levels, with a low rate of clinical events. These findings support a proactive, strain-guided cardio-oncology approach, although larger prospective studies are needed to define optimal treatment strategies in this populationTable 1For image description, please refer to the figure legend and surrounding text.