Abstract:
Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a major complication of cardiotoxic oncologic treatments. Global longitudinal strain (GLS) has emerged as a sensitive early marker of subclinical myocardial injury, and GLS-guided initiation of cardioprotective therapy (e.g., ACE inhibitors, beta-blockers) has been proposed to prevent progression to overt dysfunction. This systematic review and meta-analysis evaluated the efficacy of GLS-guided cardioprotective therapy in reducing CTRCD incidence and preserving left ventricular function in patients undergoing cardiotoxic cancer treatment.
Methods: Randomized controlled trials (RCTs) comparing GLS-guided cardioprotective therapy with standard care (or LVEF-guided monitoring) in cancer patients were identified across databases and pooled using a random-effects model. Outcomes assessed included CTRCD incidence, change in left ventricular ejection fraction (LVEF), endpoint LVEF, uptake of cardioprotective therapy, incident heart failure, and cancer therapy discontinuation/interruption. Effect estimates were expressed as risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI).
Results: Two studies (n=360) evaluated CTRCD incidence, showing a non-significant trend toward benefit with GLS-guided therapy (RR 0.43, 95% CI 0.18–1.03; I²=0%; P=0.06). Changes in LVEF (MD 1.49, 95% CI −1.53 to 4.52; I²=79%; P=0.33) and endpoint LVEF (MD 2.39, 95% CI −0.54 to 5.32; I²=82%; P=0.11) did not differ significantly between groups, exhibiting substantial heterogeneity. While uptake of cardioprotective therapy was higher in the GLS-guided arm across three studies, the pooled estimate was highly imprecise and heterogeneous (RR 14.81, 95% CI 0.44–498.30; I²=89%; P=0.13). Heart failure events (RR 0.49, 95% CI 0.06–3.75; I²=0%; P=0.49) and cancer therapy discontinuation (RR 0.58, 95% CI 0.21–1.61; I²=0%; P=0.29) were similar between arms.
Conclusion: GLS-guided cardioprotective therapy shows a promising but non-significant trend toward reducing CTRCD incidence, alongside greater uptake of cardioprotective medications without increasing oncologic treatment interruptions. However, its impact on LVEF preservation remains inconclusive due to considerable heterogeneity. Current evidence from limited trials is insufficient to firmly establish clinical benefit. Larger, standardized RCTs are required to clarify the role of strain-guided strategies in cardioncology.
Keywords: Cardio-oncology; Global longitudinal strain (GLS); Cancer therapy-related cardiac dysfunction (CTRCD); Cardioprotective therapy; Systematic review and meta-analysis; Left ventricular ejection fraction (LVEF).
Biography:
Labeeq Qureshi is an aspiring medical researcher and current medical student at Isra University in Pakistan. With a strong academic interest in cardiology and preventative medicine, Qureshi focuses on evidence-based research and systematic reviews to improve clinical outcomes. Their research interests lie at the intersection of oncology and cardiovascular health, specifically in leveraging advanced imaging modalities like global longitudinal strain (GLS) to mitigate cardiotoxicity during cancer therapy. They are actively involved in academic clinical research aimed at translating evidence into practice.
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