Predicting cardiotoxicity of antitumor therapy: an easy way to point the right direction

Aim. To discuss a new method for predicting cardiovascular toxicity of chemotherapy and targeted therapy based on echocardiographic changes of left atrial volume index (LAVI).

Material and methods. This prospective observational study was conducted at the Department of Hospital Internal Medicine № 1 of the Russian University of Medicine. The study included 149 cancer patients aged 18 to 80 years receiving antitumor treatment and at high and very high risk of cardiovascular toxicity, as defined by the Mayo Clinic (USA) score. All study participants underwent a clinical and paraclinical examination, including a patient history and complaint collection, physical examination, 12-lead electrocardiography (ECG), two-dimensional echocardiography to determine left ventricular systolic global longitudinal strain, 12-lead 24-hour ECG monitoring, and 24-hour blood pressure monitoring before the start of antitumor therapy and at 1, 3, 6, 9, and 12 months after the start of antitumor treatment. Throughout the monitoring period, the emergence of previously absent cardiovascular lesions was monitored.

Results. During the 12-month follow-up, 76 (51%) study participants were found to have various manifestations of cardiovascular toxicity. An analysis of echocardio­graphy results in patients with developed cardiovascular complications revealed left atrial dilation with an increase in LAVI to >34 ml/m². ROC analysis and the Kaplan-Meier estimator revealed that an LAVI ≥34 ml/m² corresponds to an increased risk of cardiovascular complications, including death in cancer patients.

Conclusion. The obtained results provide internists, cardiologists, and oncologists with an easily accessible and reproducible echocardiography indicator (LAVI) that can accurately cardiovascular toxicity after antitumor therapy. Based on the above, the authors submitted an application to the Federal Institute of Industrial Property and received a patent for the invention.

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