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Speckle-Tracking Echocardiography for Cardioncological Evaluation in Bevacizumab-Treated Colorectal Cancer Patients

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Abstract

Angiogenesis inhibitor Bevacizumab (BVZ) may lead to the development of adverse effects, including hypertension and cardiac ischemia. Whether assessment of changes in myocardial strain by two-dimensional speckle-tracking echocardiography (2D-STE) can be of value in detecting BVZ-mediated cardiotoxicity at an earlier stage is not known. We investigated whether 2D-STE can non-invasively detect early evidence of cardiotoxicity in metastatic colorectal cancer (mCRC) patients treated with BVZ. Between January and June 2019, 25 consecutive patients (71.8 ± 7.5 year/old, 17 males) with mCRC were prospectively enrolled. Patients underwent physical examination, blood tests, and conventional 2D-transthoracic echocardiography implemented with 2D-STE analysis, at baseline and at 3 and 6 months following treatment with BVZ (15 mg/kg every 15 days) + 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX i.v.). At 6-month follow-up, we assessed occurrence of global longitudinal strain (GLS) impairment (> 15% decrease in GLS compared with baseline) as primary end-point and a new-onset systemic hypertension (secondary end-point). On average, GLS showed a progressive significant impairment after BVZ, from − 17.4 ± 3.2% at baseline to − 16 ± 2.9% (p = 0.003) at 6-month follow-up; > 15% decrease in GLS (primary end-point) was detected in 9 patients (36%). All other strain parameters remained unchanged. New-onset systemic hypertension (secondary end-point) was diagnosed in five patients (20%). No significant changes were observed in serial high-sensitivity cardiac troponin I measurements. No patient developed significant changes in LV size or LV ejection fraction; no case of clinically symptomatic HF was observed during BVZ-treatment. Measurement of GLS by 2D-STE analysis can effectively detect BVZ-mediated cardiotoxicity at an early stage.

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Abbreviations

2D:

Two-dimensional

AFI:

Automated function imaging

AUC:

Area under the curve

AVC:

Aortic valve closure

BP:

Blood pressure

BSA:

Body surface area

BVZ:

Bevacizumab

CI:

Confidence interval

CRP:

C-reactive protein

CTRCD:

Cancer therapeutics-related cardiac dysfunction

DBP:

Diastolic blood pressure

ECG:

Electrocardiogram

GCS:

Global circumferential strain

GCSR:

Global circumferential strain rate

GLS:

Global longitudinal strain

GLSR:

Global longitudinal strain rate

GRS:

Global radial strain

GRSR:

Global radial strain rate

GSR+ :

First positive global strain rate

GSRE:

Global early-diastolic strain rate

GSRL:

Global late-diastolic strain rate

HF:

Heart failure

HR:

Heart rate

HS-cTnl:

High-sensitivity cardiac troponin I

ICC:

Intraclass correlation coefficient

LA:

Left atrial

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVFP:

Left ventricular filling pressures

mCRC:

Metastatic colorectal cancer

ROI:

Region of interest

SBP:

Systolic blood pressure

SD:

Standard deviation

SR:

Strain rate

STE:

Speckle-tracking echocardiography

TnI:

Troponin I

TnT:

Troponin T

TTE:

Transthoracic echocardiography

VEGF:

Vascular endothelial growth factor

VEGF-i:

Vascular endothelial growth factor inhibitors

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Acknowledgements

This work has been supported by Italian Ministry of Health Ricerca Corrente - IRCCS MultiMedica.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy

    Andrea Sonaglioni & Michele Lombardo

  2. Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy

    Adriana Albini

  3. Department of Oncology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy

    Emanuela Fossile & Maria Adelaide Pessi

  4. Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi

  5. Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (MI), Italy

    Claudio Anzà

  6. Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria “S. Maria Della Misericordia”, Perugia, Italy

    Giuseppe Ambrosio

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  1. Andrea Sonaglioni
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  2. Adriana Albini
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Correspondence to Adriana Albini.

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All procedures were in accordance with the ethical standards of our Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. A written informed consent was obtained from all patients, and the protocol was approved by the Independent Ethical Committee IRCCS MultiMedica (Committee’s reference number CE 98.2019).

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12012_2020_9583_MOESM1_ESM.jpg

Supplementary material 1 (JPG 1418 kb) Supplemental table. Intra- and interobserver variability analysis of the main conventional and functional echocardiographic parameters, measured in a subgroup of ten patients, randomly selected. GCS, global circumferential strain. GLS, global longitudinal strain. GSA+, positive global atrial strain. ICC, intraclass correlation coefficient. LVEF, left ventricular ejection fraction. LVMi, left ventricular mass indexed.

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Sonaglioni, A., Albini, A., Fossile, E. et al. Speckle-Tracking Echocardiography for Cardioncological Evaluation in Bevacizumab-Treated Colorectal Cancer Patients. Cardiovasc Toxicol 20, 581–592 (2020). https://doi.org/10.1007/s12012-020-09583-5

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