Background and Aims The detection of cancer therapy-related cardiac dysfunction (CTRCD) by reduction of left ventricular ejection fraction (LVEF) during chemotherapy usually triggers the initiation of cardioprotective therapy. This study addressed whether the same approach should be applied to patients with worsening of global longitudinal strain (GLS) without attaining thresholds of LVEF. Methods Strain surveillance during chemotherapy for improving cardiovascular outcomes (SUCCOUR-MRI) was a prospective multicentre randomized controlled trial involving 14 sites. Of 355 patients receiving anthracyclines with normal baseline LVEF, 333 patients (age 59 ± 13 years, 79% women) with at least one other CTRCD risk factor, able to undergo magnetic resonance imaging (MRI), GLS, and three-dimensional echocardiography were tracked over 12 months. A total of 105 patients (age 59 ± 13 years, 75% women, 69% breast cancer) developing GLS-CTRCD (>12% relative reduction of GLS without a change in LVEF) were randomized to cardioprotection with neurohormonal antagonists vs. usual care. The primary endpoint was 12-month change in MRI-LVEF; the secondary endpoint was MRI-LVEF-defined CTRCD. Results During follow-up, two patients died, and two developed heart failure. Most patients were randomized at 3 months (62%). Median doses of angiotensin inhibition/blockade and beta-blockade were 75% and 50% of respective targets; 21 (43%) had side-effects attributed to cardioprotection. Due to a smaller LVEF change from baseline with cardioprotection than usual care (−2.5 ± 5.4% vs. −5.6 ± 5.9%, P = .009), follow-up LVEF was higher after cardioprotection (59 ± 5% vs. 55 ± 6%, P < .0001). After adjustment for baseline LVEF, the mean (95% confidence interval) difference in the change in LVEF between the two groups was −3.6% (−1.8% to −5.5%, P < .001). After cardioprotection, 1/49 patients developed 12-month LVEF-CTRCD, compared to 6/56 in usual care (P = .075). Global longitudinal strain improved at 3 months post-randomization in the cardioprotection group, with little change with usual care. Conclusions In patients with isolated GLS reduction after anthracyclines, cardioprotection is associated with better preservation of 12-month MRI-LVEF compared with usual care.

中文翻译：

---

化疗期间的菌株监测以改善心血管结局： SUCCOUR-MRI 试验


背景和目的 化疗期间通过降低左心室射血分数 （LVEF） 来检测癌症治疗相关心功能障碍 （CTRCD） 通常会触发心脏保护治疗的开始。本研究探讨了是否应将相同的方法应用于整体纵向应变 （GLS） 恶化而未达到 LVEF 阈值的患者。方法 化疗期间的菌株监测以改善心血管结局 （SUCCOUR-MRI） 是一项前瞻性多中心随机对照试验，涉及 14 个地点。在 355 例接受蒽环类药物治疗且基线 LVEF 正常的患者中，333 例患者 （年龄 59 ± 13 岁，79% 为女性） 至少有一项其他 CTRCD 危险因素，能够接受磁共振成像 （MRI）、GLS 和三维超声心动图，随访超过 12 个月。共有 105 名患者 （年龄 59 ± 13 岁，75% 女性，69% 乳腺癌） 发生 GLS-CTRCD （>12% GLS 相对降低，LVEF 没有变化） 被随机分配到神经激素拮抗剂心脏保护组与常规护理组。主要终点是 MRI-LVEF 的 12 个月变化;次要终点是 MRI-LVEF 定义的 CTRCD。结果 随访期间，2 例患者死亡，2 例发生心力衰竭。大多数患者在 3 个月时被随机分组 （62%）。血管紧张素抑制/阻断和 β 受体阻滞的中位剂量分别为各自靶标的 75% 和 50%;21 例 （43%） 有归因于心脏保护的副作用。由于心脏保护相对于基线的 LVEF 变化小于常规护理 （-2.5 ± 5.4% vs. -5.6 ± 5.9%，P = .009），心脏保护后随访 LVEF 更高 （59 ± 5% vs. 55 ± 6%，P < .0001）。 调整基线 LVEF 后，两组之间 LVEF 变化的平均 （95% 置信区间） 差异为 -3.6% （-1.8% 至 -5.5%，P < .001）。心脏保护后，1/49 患者发生 12 个月的 LVEF-CTRCD，而常规护理中为 6/56 （P = .075）。心脏保护组在随机分组后 3 个月整体纵向应变有所改善，与常规护理相比变化不大。结论 在蒽环类药物后孤立性 GLS 减少的患者中，与常规护理相比，心脏保护与更好地保留 12 个月 MRI-LVEF 相关。