Speckle-tracking derived parameters of left ventricular function, repolarization and myocardial injury markers during androgen deprivation therapy

Abstract Background. Androgen deprivation therapy (ADT) and subsequent hypogonadism in patients with prostate cancer may cause cardiac toxicity. We aimed to analyse left ventricular longitudinal strain, mechanical dispersion, electrocardiographic repolarization and myocardial injury markers changes during androgen deprivation therapy in patients with advanced prostate cancer. Methods. We included 31 patients with advanced prostate cancer, in sinus rhythm, with stable cardiac conditions, and evaluated them by echocardiography, electrocardiography and blood sampling for high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-brain natriuretic peptide, at ADT initiation and after 6 months of treatment. Peak longitudinal strain by speckle-tracking echocardiography was assessed in 16 left ventricular segments and averaged to global longitudinal strain (GLS). Standard deviation of time intervals from the start of Q/R on electrocardiogram to peak longitudinal strain in the 16 segments (MDSD) and the difference between the longest and shortest time to peak strain intervals (MDdelta) were calculated as indices of mechanical dispersion. Fridericia corrected electrocardiographic repolarization parameters were analysed: QTc interval, mean and maximum values of Tpeak-Tend interval (Tpe) and Tpe/QT ratio, Tpe dispersion (Tped). Results. Significant impairments of the following parameters were registered: GLS (%) (-16.9 ± 3.9;-14.4 ± 3.6, p < 0.001); MDSD (ms) (77.4 ± 21.4;89.09 ± 27, p = 0.004), MDdelta (ms) (225.3 ± 78.3,259.9 ± 108.4, p = 0.02), QTc (ms) (458.8 ± 43.4;485.6 ± 45.1, p = 0.01), maxTpe/QT (0.246 ± 0.04;0.268 ± 0.04, p = 0.01), maxTpe (ms) (105.4 ± 23.2;119.5 ± 26.4 p = 0.01), meanTpe (ms) (83.3 ± 16.8;90.7 ± 19.3, p = 0.02), hs-cTnI (ng/mL) (4.6 ± 5.4;5.4 ± 6.4, p = 0.01). Conclusions. ADT and the subsequent hypogonadism induce alterations of GLS, mechanical dispersion, electrocardiographic repolarization parameters and elevation of hs-cTnI during the first 6 months of treatment.