Baseline Electrocardiographic and Echocardiographic Assessment May Help Predict Survival in Lung Cancer Patients-A Prospective Cardio-Oncology Study

Simple Summary Lung cancer is characterized by a high mortality rate. The main prognostic factors are histopathological and molecular diagnosis as well as clinical advancement. Performance status and comorbidities have an additional impact on the outcome. Assuming that lung cancer is often associated with cardiovascular diseases and the localization of the disease in the chest leads to exercise dyspnea, it seems valuable to objectively determine what echocardiographic parameters correlate with significantly reduced (ECOG = 2) performance status. Some echocardiographic parameters (RVSP, ACT, RV GLS, RV free wall strain, fractional area change) were associated with low performance status which can help to objectively confirm exercise intolerance in lung cancer. Moreover, recognition of atrial fibrillation and high heart rate (>90/min) in ECG strengthens the prediction of earlier death. Meanwhile, finding some positive prognostic factors like RVSP < 21 mmHg or RV free wall strain < -30% and even RV GLS < -25.5% in echocardiography allows planning of more aggressive anticancer treatment. Cardiovascular disease and cancer coexist and lead to exertional dyspnea. The aim of the study was to determine the prognostic significance of cardiac comorbidities, ECG and baseline echocardiography in lung cancer patients with varying degrees of reduced performance status. This prospective study included 104 patients with histopathologically confirmed lung cancer, pre-qualified for systemic treatment due to metastatic or locally advanced malignancy but not eligible for thoracic surgery. The patients underwent a comprehensive cardio-oncological evaluation. Overall survival negative predictors included low ECOG 2 (Eastern Cooperative Oncology Group) performance status, stage IV (bone or liver/adrenal metastases in particular), pleural effusion, the use of analgesics and among cardiac factors, two ECG parameters: atrial fibrillation (HR = 2.39) and heart rate >90/min (HR = 1.67). Among echocardiographic parameters, RVSP > 39 mmHg was a negative predictor (HR = 2.01), while RVSP < 21 mmHg and RV free wall strain < -30% were positive predictors (HR = 0.36 and HR = 0.56, respectively), whereas RV GLS < -25.5% had a borderline significance (HR = 0.59; p = 0.05). Logistical regression analysis showed ECOG = 2 significantly correlated with the following echocardiographic parameters: increasing RVSP, RV GLS, RV free wall strain and decreasing ACT, FAC (p < 0.05). Selected echocardiographic parameters may be helpful in predicting poor performance in lung cancer patients and, supplemented with ECG evaluation, broaden the possibilities of prognostic evaluation.

Automated summary

Lung cancer is a highly lethal disease, and its prognosis is influenced by histopathological and molecular diagnosis, clinical advancement, performance status, and comorbidities. Certain echocardiographic parameters are associated with poor performance status, providing objective confirmation of exercise intolerance in lung cancer patients. Atrial fibrillation and high heart rate in electrocardiogram are predictive of early death. Selected echocardiographic parameters can help predict poor prognosis in lung cancer patients and, when combined with electrocardiogram evaluation, broaden the possibilities of prognostic assessment.