Simultaneous Left Ventricular Volume and Strain Changes During Chemotherapy Associate With 2‐Year Postchemotherapy Measures of Left Ventricular Ejection Fraction

Abstract

Background Although changes in left ventricular end‐systolic volume ( LVESV ), left ventricular end‐diastolic volume, and global circumferential strain occur during cancer treatment, the relationship of these changes to the 2‐year post–cancer‐treatment measures of left ventricular ejection fraction ( LVEF ) are unknown. Methods and Results In a prospective, continuously recruited cohort of 95 patients scheduled to receive potentially cardiotoxic chemotherapy for breast cancer, lymphoma, or soft tissue sarcoma, measures of left ventricular end‐diastolic volume, LVESV , global circumferential strain, and LVEF were acquired via cardiac magnetic resonance imaging before and then 3 and 24 months after initiating treatment by individuals blinded to all patient identifiers. Participants had an average age of 54±15 years; 68% were women, and 82% were of white race. LVEF declined from 62±7% to 58±9% over the 24 months ( P <0.0001), with 42% of participants experiencing a >5% decline in LVEF at 24 months. Predictors of a 24‐month >5% decline in LVEF included the following factors from baseline to 3 months into treatment: (1) >3‐mL increases in LVESV ( P =0.033), (2) >3‐mL increases in LVESV or 10‐mL declines in left ventricular end‐diastolic volume with little change in LVESV ( P =0.001), or (3) ≥10% deteriorations in global circumferential strain with little change in LVESV ( P =0.036). Conclusion During receipt of potentially cardiotoxic chemotherapy, increases in LVESV , the absence of its deterioration during decreases of left ventricular end‐diastolic volume, or the deterioration of global circumferential strain without a marked decrease in LVESV help identify those who will develop more permanent 2‐year declines in LVEF .