Reference values of strain-derived myocardial work indices in adult cancer survivors: results from an observational study and comparison with data from the EACVI NORRE population

Adult cancer survivors of haematological malignancies are at increased risk of cardiovascular morbidity and mortality. Several echocardiographic markers have been investigated to detect subclinical myocardial dysfunction in this population. Myocardial work (MW) is a load independent echocardiographic method, which conjugates non-invasive arterial blood pressure and global longitudinal strain (GLS). However, normal ranges of MW indices in cancer survivors have not been defined.

In this observational, prospective study, 63 Hodgkin Lymphoma patients [49% male, median age 42 (33,0–50,5) years], free of malignancy recurrence, without declared cardiological symptoms and known cardiovascular disease history, were finally included. MW indices were performed and compared with results from the EACVI NORRE Study. Mean left ventricular ejection fraction was 57,0 (55,0-60,0), while mean GLS was -18,0% (-19,2-17,1). Global work efficiency [GWE, 96% (94-97)], global work index (GWI, 1732±340 mmHg%) and global wasted work [GWW, 78 (55-131) mmHg%] did not differ between genders. Global constructive work (GCW, 2116±386 mmHg%) was instead lower in males. GWI and GCW resulted lower in cancer survivors when compared to the EACVI NORRE population (p=0,0008 and p=0,0324, respectively). Furthermore, associations of MW indices with patient characteristics were explored.

For the first time, this report provides ranges of MW in an homogeneous HL asymptomatic survivors without cardiovascular disease. GWI and GCW were significantly lower from those previously reported in healthy volunteers, providing evidence for MW metrics application as precocious markers of subclinical dysfunction in this setting. Further research is therefore needed.