MODERN STRATEGIES FOR EARLY DETECTION OF CANCER THERAPY-RELATED CARDIAC DYSFUNCTION: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS
TL;DR
Its use facilitates early detection of subclinical dysfunction and, in selected settings, may improve preservation of left ventricular function; however, a long-term benefit has not been established.
Abstract
Relevance: Cancer therapy-related cardiac dysfunction is a significant complication of cancer treatment. Conventional monitoring primarily relies on left ventricular ejection fraction (LVEF). A decrease in LVEF may indicate dysfunction only after it has already developed. Global longitudinal strain and cardiac biomarkers can detect subclinical changes earlier.The study aimed to evaluate the effectiveness of strategies for early detection of cancer therapy-related cardiac dysfunction using global longitudinal strain and cardiac biomarkers to facilitate timely initiation of cardioprotective therapy and preserve left ventricular function.Materials and Methods: We conducted a systematic review of randomized controlled trials in PubMed/MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. We assessed risk of bias using the Cochrane Risk of Bias 2 tool and evaluated certainty of evidence using the GRADE system. Because of heterogeneity across studies, we performed a structured descriptive synthesis.Results: Of the 82 records identified, four randomized controlled trials were included in the final synthesis: SUCCOUR, SUCCOUR-MRI, Cardiac CARE, and a study guided by N-terminal pro-B-type natriuretic peptide. In SUCCOUR, the incidence of cardiac dysfunction at 1 year was lower with a strategy based on global longitudinal strain than with LVEF-guided monitoring (5.8% vs. 13.7%; p = 0.02). In SUCCOUR-MRI, the decline in LVEF at 12 months was less pronounced with early cardioprotective therapy (-2.5±5.4% vs. -5.6±5.9%; p = 0.009). In Cardiac CARE, a strategy based on high-sensitivity cardiac troponin I monitoring did not improve LVEF (p = 0.82). With N-terminal pro-B-type natriuretic peptide monitoring, LVEF was 2.0 percentage points higher at 3 months; however, this benefit was not sustained over the long term.Conclusion: The strongest evidence was for global longitudinal strain. Its use facilitates early detection of subclinical dysfunction and, in selected settings, may improve preservation of left ventricular function; however, a long-term benefit has not been established. High-sensitivity cardiac troponin I alone did not improve left ventricular function, whereas N-terminal pro-B-type natriuretic peptide-guided monitoring requires further investigation.