Browsing by Author "Rhea, Isaac B."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Incremental Prognostic Value of Echocardiographic Strain and Its Association with Mortality in Cancer Patients
    (Elsevier, 2015-06) Rhea, Isaac B.; Uppuluri, Sarada; Sawada, Stephen; Schneider, Bryan P.; Feigenbaum, Harvey; Department of Medicine, IU School of Medicine
    Background Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. Methods In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. Results Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P < .10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54–2.92; P < .001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14–3.27; P = .014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81–0.97; P = .012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ2 value after adding GLS (P = .011) to significant clinical variables. Conclusions Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.
  • Thumbnail Image
    Item
    Prognostic utility of blood pressure-adjusted global and basal systolic longitudinal strain
    (Bioscientifica, 2016-03) Rhea, Isaac B.; Rehman, Shuja; Jarori, Upasana; Choudhry, Muhammad W.; Feigenbaum, Harvey; Sawada, Stephen G.; Department of Medicine, IU School of Medicine
    Assessment of global longitudinal systolic strain (GLS) and longitudinal systolic strain of the basal segments (BLS) has shown prognostic value in cardiac disorders. However, strain is reduced with increased afterload. We assessed the prognostic value of GLS and BLS adjusted for afterload. GLS and BLS were determined in 272 subjects with normal ejection fraction and no known coronary disease, or significant valve disease. Systolic blood pressure (SP) and diastolic blood pressure (DP) obtained at the time of echocardiography were used to adjust GLS and BLS as follows: strain×SP (mmHg)/120 mmHg and strain×DP (mmHg)/80 mmHg. Patients were followed for cardiac events and mortality. The mean age was 53±15 years and 53% had hypertension. There were 19 cardiac events and 70 deaths over a mean follow-up of 26±14 months. Cox analysis showed that left ventricular mass index (P=0.001), BLS (P<0.001), and DP-adjusted BLS (P<0.001) were independent predictors of cardiac events. DP-adjusted BLS added incremental value (P<0.001) to the other two predictors and had an area under the curve of 0.838 for events. DP (P=0.001), age (P=0.001), ACE inhibitor use (P=0.017), and SP-adjusted BLS (P=0.012) were independent predictors of mortality. SP-adjusted BLS added incremental value (P=0.014) to the other independent predictors. In conclusion, DP-adjusted BLS and SP-adjusted BLS were independent predictors of cardiac events and mortality, respectively. Blood pressure-adjusted strain added incremental prognostic value to other predictors of outcome.