Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes: The SUCCOUR Trial

SUCCOUR Investigators

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

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)

Original languageEnglish
Pages (from-to)1098-1105
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume11
Issue number8
DOIs
StatePublished - Aug 2018

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Drug Therapy
Stroke Volume
Randomized Controlled Trials
Heart Failure
Anthracyclines
Therapeutics
Lymphoma
Diabetes Mellitus
Clinical Trials
Guidelines
Breast Neoplasms
Hypertension
Neoplasms

Keywords

  • chemotherapy-related cardiac dysfunction
  • global longitudinal strain
  • left ventricular ejection fraction

Cite this

@article{71b39f4f0c764724b19db6b34222a110,
title = "Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes: The SUCCOUR Trial",
abstract = "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)",
keywords = "chemotherapy-related cardiac dysfunction, global longitudinal strain, left ventricular ejection fraction",
author = "{SUCCOUR Investigators} and Tomoko Negishi and Paaladinesh Thavendiranathan and Kazuaki Negishi and Marwick, {Thomas H.} and Svend Aakhus and Klaus Murbr{\ae}ch and Richard Massey and Manish Bansal and Nobuaki Fukuda and Krassimira Hristova and Masaki Izumo and {La Gerche}, Andre and Ben Costello and Julie Lemieux and Cot{\'e}, {Marc Andre} and Jonathan Deblois and Philip Mottram and Sakiko Miyazaki and Mark Nolan and Martin Penicka and Tomas Ondrus and Evangelos Stefanidis and St{\'e}phanie Seldrum and Mitra Shirazi and Evgeny Shkolnik and Eitan Amir and Babitha Thampinathan and Liza Thomas and Hirotsugu Yamada and Dragos Vinereanu and Popescu, {Bogdan A.} and Diana Mihalcea and Andreea Calin and Cho, {Goo Yeong} and Cho, {Goo Yeong} and Maurizio Galderisi and Ciro Santoro",
year = "2018",
month = "8",
doi = "10.1016/j.jcmg.2018.03.019",
language = "English",
volume = "11",
pages = "1098--1105",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "8",

}

Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes : The SUCCOUR Trial. / SUCCOUR Investigators.

In: JACC: Cardiovascular Imaging, Vol. 11, No. 8, 08.2018, p. 1098-1105.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes

T2 - The SUCCOUR Trial

AU - SUCCOUR Investigators

AU - Negishi, Tomoko

AU - Thavendiranathan, Paaladinesh

AU - Negishi, Kazuaki

AU - Marwick, Thomas H.

AU - Aakhus, Svend

AU - Murbræch, Klaus

AU - Massey, Richard

AU - Bansal, Manish

AU - Fukuda, Nobuaki

AU - Hristova, Krassimira

AU - Izumo, Masaki

AU - La Gerche, Andre

AU - Costello, Ben

AU - Lemieux, Julie

AU - Coté, Marc Andre

AU - Deblois, Jonathan

AU - Mottram, Philip

AU - Miyazaki, Sakiko

AU - Nolan, Mark

AU - Penicka, Martin

AU - Ondrus, Tomas

AU - Stefanidis, Evangelos

AU - Seldrum, Stéphanie

AU - Shirazi, Mitra

AU - Shkolnik, Evgeny

AU - Amir, Eitan

AU - Thampinathan, Babitha

AU - Thomas, Liza

AU - Yamada, Hirotsugu

AU - Vinereanu, Dragos

AU - Popescu, Bogdan A.

AU - Mihalcea, Diana

AU - Calin, Andreea

AU - Cho, Goo Yeong

AU - Cho, Goo Yeong

AU - Galderisi, Maurizio

AU - Santoro, Ciro

PY - 2018/8

Y1 - 2018/8

N2 - 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)

AB - 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)

KW - chemotherapy-related cardiac dysfunction

KW - global longitudinal strain

KW - left ventricular ejection fraction

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U2 - 10.1016/j.jcmg.2018.03.019

DO - 10.1016/j.jcmg.2018.03.019

M3 - Article

C2 - 29909105

AN - SCOPUS:85048176170

VL - 11

SP - 1098

EP - 1105

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 8

ER -