Cardiotoxicity surveillance via myocardial work among cancer patients treated with immunotherapy

Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment; however, the risk of cardiotoxicity has increased due to inadequate data for improving management and prevention strategies. Methods In this single-centre, prospective observational study, ICI-treated patients underwent biomarker assessments and echocardiography to measure global longitudinal strain (GLS) and myocardial work (MW) at baseline, 2 months, and every 3 months for one year or until treatment was discontinued. Cardiotoxicity was defined as a ≥ 10% reduction in left ventricular ejection fraction (LVEF) to < 50%, troponin elevation of ≥ 0.30 ng/ml, or ≥ 15% relative reduction in GLS. Results Among 63 patients, 39 (62%) completed at least two evaluations (56% male, 61% smokers, and 54% lung cancer patients). The overall incidence of cancer therapy-related cardiac dysfunction (CTRCD) was 26%, with half of these patients experiencing a ≥ 10% reduction in LVEF. The CTRCD group presented a lower baseline LVEF (67% vs. 62%, p = 0.014). Concurrent chemotherapy and higher baseline coronary calcium scores were not linked to CTRCD risk, and no CTRCD cases were noted in patients on beta-blockers. Additionally, significant reductions in MW parameters were observed in the CTRCD group at 2 months. Conclusions Our findings highlight an unexpectedly high incidence of noninflammatory left ventricular dysfunction when sensitive measurement tools are used. These findings underscore the need for further studies to validate MW as a tool for cardiological surveillance and early diagnosis of CTRCD in patients receiving ICIs.