Preoperative TnP for Bladder Cancer Alters Cardiac Function Parameters

Preoperative immunotherapy plus chemotherapy (tislelizumab with nab-paclitaxel [TnP]) significantly altered electrocardiography (ECG) and other cardiac parameters in patients with bladder cancer (BC). These study findings were reported in the journal Annals of Noninvasive Electrocardiography.

This study was a retrospective analysis of data from 2 ongoing clinical trials (ClinicalTrials.gov Identifiers: NCT04730219 and NCT04730232) evaluating the safety and efficacy of TnP in patients with bladder cancer. Patients with either muscle-invasive bladder cancer (MIBC) or non-muscle-invasive bladder cancer (NMIBC) underwent baseline and serial cardiovascular assessments. 

Those with MIBC were treated with 3 cycles of TnP, and those with NMIBC were treated with 4 cycles of TnP. Results were reported as means, medians, frequencies, or percentages, based on each variable and its distribution in the population.

A total of 60 patients were included in analyses, of whom 30 had MIBC and 30 had NMIBC. The mean age of patients overall was 66.4 years (SD, 10.2) at diagnosis. At baseline, hypertension was reported in 25 (41.7%) patients overall, with diabetes mellitus in 8 (13.3%) patients and coronary artery disease in 5 (8.3%) patients. Additionally, 25 (41.7%) patients were being treated with cardiovascular drugs at baseline.

After treatment with TnP, the biomarkers cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were considered to be within normal ranges. cTnI values were reported to be 0.011 ng/mL before treatment and 0.013 ng/mL after treatment (P =.367). NT-proBNP levels were reported to be 148.0 ng/L before treatment and 146.9 ng/L after treatment (P =.735). 

Patients were reported to have preserved left ventricular ejection fraction (LVEF), as observed through transthoracic echocardiography and based on having a LVEF of 50% or greater. However, LVEF was reported to have decreased from 62.81%±3.81% before treatment to 61.10%±4.37% after treatment (P =.011).

Additionally, ECG abnormalities were reported in 65.0% of patients at baseline, and this rate rose to 76.7% of patients after treatment. The prevalence of fragmented QRS (fQRS) increased from 33.3% to 50.0% during this time (P =.013), mostly involving the inferior leads. 

QT dispersion (QTd) also became significantly longer with TnP treatment, increasing from 39.50±11.37 milliseconds before treatment to 44.20±15.85 milliseconds after treatment (P =.019). P-wave duration showed a decrease with treatment from 108.03±10.32 to 104.07±12.33 milliseconds (P =.019). QRS duration shifted from 94.4±12.39 to 92.63±12.37 milliseconds (P =.009) with treatment, and T-peak to T-end value decreased from 85.17±12.83 to 77.67±10.29 milliseconds (P <.05) with treatment.

“In summary, ECG parameters including fQRS and QTd were significantly altered in [bladder cancer] patients receiving preoperative chemotherapy combined with immunotherapy,” the researchers wrote in their report.