title: Cardiac mechanics and dysfunction with anthracyclines in the community: results from the PREDICT study.
abstract: Our objective was to determine the relevance of changes in myocardial mechanics in diagnosing and predicting cancer therapeutics-related cardiac dysfunction (CTRCD) in a community-based population treated with anthracyclines.
  
  
  
  Quantitative measures of cardiac mechanics were derived from 493 echocardiograms in 165 participants enrolled in the PREDICT study (A Multicenter Study in Patients Undergoing AnthRacycline-Based Chemotherapy to Assess the Effectiveness of Using Biomarkers to Detect and Identify Cardiotoxicity and Describe Treatment). Echocardiograms were obtained primarily at baseline (prior to anthracyclines), 6 and 12 months. Predictors included changes in strain; strain rate; indices of contractile function derived from the end-systolic pressure-volume relationship (end-systolic elastance (Eessb) and the left ventricular (LV) volume at an end-systolic pressure of 100 mm Hg (V100)); total arterial load (effective arterial elastance (Ea)) and ventricular-arterial coupling (Ea/Eessb). Logistic regression models determined the diagnostic and prognostic associations of changes in these measures and CTRCD, defined as a LV ejection fraction decline ≥10 to <50%.
  
  
  
  By 12 months, 31 participants developed CTRCD. Longitudinal and circumferential strain and strain rate, V100, Ea, and Ea/Eessbeach demonstrated significant diagnostic associations, with a 1-7% increased odds of CTRCD (p<0.05). Changes in longitudinal strain rate (area under the curve (AUC) 0.719 (95% CI 0.595 to 0.843)), V100(AUC 0.796 (95% CI 0.686 to 0.903)) and Ea (AUC 0.742 (95% CI 0.632 to 0.852)) from baseline to 6 months were individually predictive of CTRCD at 12 months.
  
  
  
  Changes in non-invasively derived measures of myocardial mechanics are diagnostic and predictive of cardiac dysfunction with anthracycline chemotherapy in community populations. Our findings support the non-invasive assessment of measures of myocardial mechanics more broadly in clinical practice and emphasise the role of serial assessments of these measures during and after cardiotoxic cancer therapy.
  
  
  
  NCT01032278; Pre-results.
authors.affiliation: Division of Cardiology, Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania , USA.
authors.forename: Hari K
authors.initials: HK
authors.lastname: Narayan
authors.affiliation: Department of Biostatistics , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.affiliation: Department of Biostatistics , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA.
authors.forename: Ziding
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Medicine , Vanderbilt University Medical Center , Nashville, Tennessee , USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lenihan
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine , The University of Pennsylvania , Philadelphia, Pennsylvania , USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Plappert
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine , The University of Pennsylvania , Philadelphia, Pennsylvania , USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Englefield
authors.affiliation: Department of General Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics and Epidemiology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
keywords: HEART FAILURE