Improved cancer treatment means we are now seeing patients live long enough for the cardiac toxicity effects of chemotherapy to become the main determinant of quality of life, and in some cases causing premature mortality. The SUCCOUR (Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes) trails seek to show that information from a specific technique called strain, used in cardiac imaging surveillance, leads to the use of adjunctive cardioprotective therapy that will limit the development of reduced cardiac function (measured as ejection fraction, EF) at one-year post chemotherapy (primary outcome), and interruptions to planned chemotherapy and the development of heart failure in follow-up (secondary outcomes).
This project was subdivided into SUCCOUR-3DE and SUCCOUR-CMR.
SUCCOUR-3DE was a multicentre international randomised trial of strain imaging for early detection and management of chemotherapy-related cardiotoxicity. All patients undergoing potentially toxic chemotherapy were randomised to strain imaging (or not) and treated according to the results. The trial showed that the change in cardiac function after chemotherapy was small, and there was no overall benefit from strain-guided surveillance. However, this strategy did reduce the number of patients developing clear evidence of cardiac toxicity from chemotherapy (ie a meaningful reduction of EF to below the normal range). Fortunately, these changes of cardiac fnction largely resolved over the subequent 2 years.
Outputs
- Cardioprotection using strain-guided management of potentially cardiotoxic cancer therapy: 3-year results of the SUCCOUR Trial
JACC: Cardiovascular Imaging - Strain-guided management of potentially cardiotoxic cancer therapy (1-year results)
JACC - Rationale and design of the strain surveillance of chemotherapy for improving cardiovascular outcomes: the SUCCOUR Trial
JACC: Cardiovascular Imaging
SUCCOUR-CMR was a multicentre Australian randomised trial of cardioprotection in just those patients with abnormal strain response to chemotherapy, using cardiac magnetic resonance-measured ejection fraction as the primary endpoint. This study showed that strain-guided therapy resulted in a smaller reduction of cardiac function than the current approach, using EF to guide chemotherapy. We think this is because strain is more sensitive to minor change in cardiac function, so patients can be treated earlier – and earlier treatment id more effective.
Outputs
- Strain surveillance during chemotherapy to improve cardiovascular outcomes: the SUCCOUR-MRI trial
European Heart Journal
What does it all mean?
Strain measurments are informative in patients undergoing postential cardiotoxic chemotherapy for cancer, and the use of this test to guide protection measures seems to be beneficial to cardiac function.
Thank you!
The Imaging Research team would like to provide our sincere thanks to the paticipants in these trials.