CHEMOTHERAPY-INDUCED ECHOCARDIOGRAPHY CHANGES IN HEPATOCELLULAR CARCINOMA PATIENTS

Abstract

Introduction. Cardiovascular diseases (CVD) still remain a major health problem, occupying a leading position in the
structure of morbidity and mortality. The incidence of comorbidities increases with age and when CVD is added to cancer, it
becomes a major healthcare problem.
The aim. To identify earlier echocardiographic changes in myocardial dysfunction in patients with hepatocellular
carcinoma without cardiovascular disease receiving targeted therapy along or in combination with transcatheter arterial
embolization (TACE).
Materials and methods. In this prospective study, 73 patients undergoing targeted therapy by sorafenib and targeted
therapy by sorafenib + TACE (doxorubicin) for hepatocellular carcinoma, underwent serial echocardiograms pre- and 6
months during therapy. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and left
ventricular end-systolic volume (LVESV) and global longitudinal strain (GLS) of the left ventricle. The mean values of the
listed echocardiography parameters were assessed both within groups over time and between groups of patients receiving
different treatment protocols. The nonparametric method U Mann-Whitney (between groups) and Wilcoxon criterion (within
group) were used for samples with irregular distribution. Student's t-test was used for parameters with normal distribution.
Statistically significant differences were considered at p<0.05.
Results. Baseline left ventricular ejection fraction (LVEF) before targeted therapy along and targeted therapy + TACE
was 61,6±4,4% vs 58,2±3,9% respectively. LVEF, LVEDV and LVESV there were no statistically significant changes in
ejection fraction within 6 months from the start of therapy. However, we found a statistically significant decrease in GLS: -
14,2±2,9 and -14,8±2,2, p=0,044 in both groups after 6 months targeted therapy; -20,1±2,6 and -14,2±2,9, p=0,029 in target
therapy along group in dynamics after 6 months of therapy; -20,4±2,0 and -14,8±2,2, р=0,036 in target therapy + TACE
group in dynamics after 6 months of therapy.
Conclusion. GLS can be used to determine preclinical myocardial systolic dysfunction in patients undergoing anticancer
therapy.