Assessing cardiac function post chemotherapy combined with immune checkpoint inhibitors via automated two-dimensional speckle tracking

Abstract

Background Although left ventricular (LV) dysfunction has been studied in patients with solid tumors and abnormal myocardial enzymes receiving immune checkpoint inhibitors, little is known about the early changes in LV strains and function in patients without significant markers of myocardial injury. Methods A total of 57 patients with solid tumors who received chemotherapy and immune checkpoint inhibitors were enrolled from December 2019 to June 2022. Echocardiography was performed at baseline and after 3 and 6 months. LVD, LVS, Volume D, Volume S, LVEF, Em, Am, E/A, E/e’, heart rate, and GLS were collected by 2 DE. Serum biomarkers of myocardial injury were tested at baseline and after 3 and 6 months. The discrimination of echocardiographic parameters and biomarkers between groups was statistically analyzed using SPSS version 19.0 software. Results A total of 49 patients (35 males; mean age ± SD, 57.5 ± 9.89 years) were included in this study. No significant differences were found in conventional ultrasound parameters, or HR throughout the follow-up period. The LA area decreased from 16.44 ± 4.17 at baseline to 15.13 ± 4.01 at 6-month follow-up (p < 0.001). Compared to baseline, the GLSs at the 3-month follow-up and 6-month follow-up were significantly reduced (p < 0.05). The creatine kinase and CK-MB levels showed an upward trend (p < 0.05). The levels of lactate dehydrogenase isoenzyme (p < 0.05) decreased at 3 months and increased at 6 months. E/e’ was negatively correlated with troponin T, creatine kinase, and blood glucose levels (r=-0.477, -0.258, -0.426, respectively; p < 0.05). GLS (3P) levels were positively correlated with creatine kinase (r = 0.017, p < 0.05). Patients were divided into two groups based on the presence (G1,15 cases) of other system immune responses or absence (G0, 34 cases) of other system immune responses. There were statistical differences in EF values among different time points (p < 0.05). There was no statistically significant difference in left ventricular strain parameters between the G0 and G1 groups (p > 0.05), but significant differences were observed at different time points (p < 0.05). Conclusions The evaluation of left ventricular strain parameters by echocardiography is of great significance for early detection of myocardial toxicity caused by immunotherapy without evidence of elevated myocardial enzymes. Trial registration : retrospectively registered