FOLFOX/CAPEOX chemotherapy induces early myocardial mechanical inefficiency, and myocardial work parameters are sensitive monitoring markers whose integrated model enhances early detection of subclinical cardiac injury.
Global longitudinal strain (GLS) decreased significantly after the first chemotherapy cycle in colorectal cancer patients receiving FOLFOX/CAPEOX.
Global work index (GWI) declined significantly after the first chemotherapy cycle.
Global work efficiency (GWE) was significantly reduced and global wasted work (GWW) was significantly increased after the first chemotherapy cycle.
A combined myocardial work model predicted subclinical cardiac dysfunction with superior accuracy compared to GLS alone.
Significant cardiac dysfunction was detectable as early as the first chemotherapy cycle in colorectal cancer patients receiving FOLFOX/CAPEOX.
This research suggests that chemotherapy drugs commonly used to treat colorectal cancer (FOLFOX and CAPEOX regimens) can cause measurable damage to heart muscle function very early in treatment—even after just the first cycle. The study used a noninvasive ultrasound-based technique called pressure-strain loop analysis to track how efficiently heart muscle contracts and relaxes over the course of treatment. Key measurements, including how much useful and wasted work the heart performs, all showed significant worsening early on, before patients would typically show any outward symptoms of heart problems. The study also found that using a combination of four heart function measurements together (rather than relying on a single measurement) was better at identifying early, hidden cardiac injury. The combined model had an area under the curve (AUC) of 0.875 compared to 0.813 for the most commonly used single measure (global longitudinal strain), and this difference was statistically significant. This means the combined approach is more accurate at flagging which patients may be developing chemotherapy-related heart damage before it becomes clinically apparent. This research suggests that noninvasive pressure-strain loop monitoring could be a valuable tool for oncology and cardiology teams to track heart health in colorectal cancer patients throughout chemotherapy. Early detection of subclinical cardiac dysfunction could allow for timely intervention, potentially preventing more serious heart complications. The findings highlight that the heart may be affected much sooner during treatment than previously recognized with standard monitoring approaches.
Guo X, Liu Y, Qin W, Wang Z, Chen C, Dong S, et al.. (2026). Noninvasive Left Ventricular Pressure-Strain Loop for Evaluating Changes in Left Ventricular Function in Colorectal Cancer Patients After Chemotherapy.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70519