AIM: The objective was to assess chemotherapy-induced cardiotoxicity by comparing changes in myocardial work indices (MWI) using echocardiographic myocardial work (MW).
MATERIAL AND METHOD: A comprehensive search was performed in PubMed, Embase, and the Cochrane Library, covering literature up to June 2024.
RESULTS: A total of 13 non-randomized experimental studies (n=1,373) assessed changes in MWI of cancer patients treated with anthracyclines, trastuzumab/pertuzumab, or immune checkpoint inhibitors. After chemotherapy, adecrease was observed in the left ventricular ejection fraction (LVEF) (Pooled standard mean difference [SMD] = -0.75, 95% CI: -1.18, -0.31, p=0.001, I 2= 95.9%), global longitudinal strain (GLS) (Pooled SMD = -2.38, 95% CI: -3.10, -1.66, p<0.001, I 2= 97.9%), global work index (Pooled SMD = -1.27, 95% CI: -1.68, -0.86, p<0.001, I2= 95.0%), global constructive work (GCW) (Pooled SMD = -1.55, 95% CI: -2.10, -0.99, p<0.001, I 2= 96.9%), and global work efficiency (Pooled SMD = -1.66, 95% CI: -2.39, -0.94, p<0.001, I2= 98.2%). Conversely, global wasted work (GWW) increased (Pooled SMD = 1.17, 95% CI: 0.44, 1.89, p=0.002, I 2= 98.2%). Post-chemotherapy, GCW and GLS were below normal ranges, GWW exceeded normal values, and LVEF remained within normal limits across all subgroups.
CONCLUSIONS: Echocardiographic MWI provides a non-invasive method for assessing cardiotoxicity induced by anthracyclines, trastuzumab / pertuzumab, or immune checkpoint inhibitors.
