Author + information
- Received December 14, 2017
- Revision received February 17, 2018
- Accepted March 28, 2018
- Published online August 6, 2018.
- Tomoko Negishi, MDa,
- Paaladinesh Thavendiranathan, MD, SMb,
- Kazuaki Negishi, MD, PhDa,
- Thomas H. Marwick, MBBS, PhD, MPHa,c,∗ (, )
- on behalf of the SUCCOUR investigators
- aMenzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- bToronto General Hospital, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, University of Toronto, Toronto, Canada
- cBaker Heart and Diabetes Research Institute, Melbourne, Australia
- ↵∗Address for correspondence:
Prof. Thomas H. Marwick, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic 3004, Australia.
Objectives This study sought to evaluate the hypothesis that global longitudinal strain (GLS) guidance of cardioprotective therapy would improve cardiac function of at-risk patients undergoing potentially cardiotoxic chemotherapy, compared with usual care.
Background The conventional criteria for diagnosis of chemotherapy-related cardiac dysfunction (CTRCD) are dependent on the recognition of heart failure symptoms and/or changes in left ventricular ejection fraction. However, the measurement variability of left ventricular ejection fraction necessitates broad diagnostic ranges, with the consequence of low sensitivity for CTRCD. Observational data have shown GLS to be a robust and sensitive marker to predict CTRCD and thereby guide the initiation of cardioprotective therapy, but these data are insufficient to justify changing the diagnostic criteria for CTRCD.
Methods The SUCCOUR (Strain sUrveillance of Chemotherapy for improving Cardiovascular Outcomes) trial is an international multicenter prospective randomized controlled trial. Patients who are taking cardiotoxic chemotherapy (n = 320) with at least 1 risk factor will be randomly allocated into GLS- and ejection fraction–guided strategies. All participants will be followed over 3 years for the primary endpoint (change in 3-dimensional ejection fraction) and other secondary endpoints.
Results Among the first 185 patients (age 54 ± 13 years; 93% women) from 23 international sites, 88% had breast cancer, 9% had lymphoma, and 3% had other cancers. Heart failure risk factors were prevalent: 34% had hypertension and 10% had diabetes mellitus. The most common chemotherapy regimen during this study was the combination of anthracycline and trastuzumab. The baseline 3-dimensional left ventricular ejection fraction was 61 ± 4%, and GLS was 20.3 ± 2.5%. Of 93 patients followed up in the first year of the study, 10 had to withdraw for noncardiac reasons. Of 40 patients randomized to the GLS-guided arm, 15 have been started on cardioprotective therapy, whereas 4 of 46 patients in the ejection fraction–guided arm have been started on therapy.
Conclusions The SUCCOUR trial will be the first randomized controlled trial of GLS and will provide evidence to inform guidelines regarding the place of GLS for surveillance for CTRCD. (Strain sUrveillance of Chemotherapy for improving Cardiovascular Outcomes [SUCCOUR]; ANZ Clinical Trials ACTRN12614000341628)
- chemotherapy-related cardiac dysfunction
- global longitudinal strain
- left ventricular ejection fraction
The SUCCOUR trial is supported in part by a Project Grant from the National Health and Medical Research Council, Canberra, Australia (1119955). The SUCCOUR trial receives software and core laboratory support from GE Medical Systems. Dr. Thavendiranathan is supported by the Canadian Institutes of Health Research New Investigator Award (FRN 147814). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Jae K. Oh, MD, served as the Guest Editor for this paper.
- Received December 14, 2017.
- Revision received February 17, 2018.
- Accepted March 28, 2018.
- 2018 American College of Cardiology Foundation
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