title: Predictors of incipient dysfunction of all cardiac chambers after treatment of metastatic renal cell carcinoma by tyrosine kinase inhibitors.
abstract: OBJECTIVE
  We aimed to explore the hypothesis that early subclinical cardiac chamber dysfunction secondary to tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma could be signaled by abnormal cardiac mechanics demonstrated by velocity vector imaging.
  
  
  METHODS
  Echocardiographic images were acquired from the apical views in 23 metastatic renal cell carcinoma patients. All patients had baseline and at least a 3-month follow-up echocardiogram after receiving TKI therapy. Subendocardial borders of all the cardiac chambers were traced to obtain volumetric and deformation indices.
  
  
  RESULTS
  Mean age was 67 ± 9 years with 92% men. The right ventricle peak systolic global longitudinal strain (GLɛ) and strain rate were significantly lower after TKIs (-23.49 ± 5.1 versus -19.81 ± 5.5, p = 0.002 and -1.52 ± 0.52 versus -1.24 ± 0.35 p = 0.02, respectively). LV GLɛ was not statistically different. Volumetric and deformation indices showed a minimal decrease of the right atrium reservoir and conduit functions, and no significant changes of left atrial function.
  
  
  CONCLUSIONS
  The right heart exhibited greater strain changes than the left heart after TKI treatment. The implications of these findings and their potential significance warrant further work.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Sherif
authors.initials: S
authors.lastname: Moustafa
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Thai H
authors.initials: TH
authors.lastname: Ho
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Parth
authors.initials: P
authors.lastname: Shah
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Katie
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Bhargava K
authors.initials: BK
authors.lastname: Nelluri
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Howard
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Susan
authors.initials: S
authors.lastname: Wilansky
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ.
authors.forename: Farouk
authors.initials: F
authors.lastname: Mookadam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D018754:Ventricular Dysfunction / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D047428:Protein Kinase Inhibitors
keywords: cardiac chambers; echocardiography; function; renal cell carcinoma; tyrosine kinase inhibitors; velocity vector imaging