通过化疗期间左心室射血分数（LVEF）降低来检测癌症治疗相关的心脏功能障碍（CTRCD）通常会触发心脏保护治疗的开始。本研究探讨了是否应将相同的方法应用于整体纵向应变 (GLS) 恶化而未达到 LVEF 阈值的患者。化疗期间应变监测以改善心血管结果 (SUCCOUR-MRI) 是一项涉及 14 个中心的前瞻性多中心随机对照试验。在 355 名接受蒽环类药物且基线 LVEF 正常的患者中，有 333 名患者（年龄 59±13 岁，79% 女性）至少有一种其他 CTRCD 危险因素，能够接受磁共振成像 (MRI)、GLS 和 3D 超声心动图检查超过 12 年几个月。共有 105 名患者（年龄 59±13 岁，75% 女性，69% 乳腺癌）发生 GLS-CTRCD（GLS 相对降低 12%，但 LVEF 没有变化），神经激素拮抗剂心脏保护与常规护理之间进行随机分组。主要终点是 MRI-LVEF 的 12 个月变化；次要终点是 MRI LVEF 定义的 CTRCD。随访期间，2 名患者死亡，2 名患者出现心力衰竭。大多数患者在 3 个月时被随机分配（62%）。血管紧张素抑制/阻断和β-阻断的中位剂量分别为目标值的75%和50%； 21 人 (43%) 出现因心脏保护引起的副作用。由于心脏保护后 LVEF 相对于基线的变化比常规治疗更小（-2.5±5.4% vs -5.6±5.9%，p=0.009），因此心脏保护后随访 LVEF 更高（59±5% vs 55±6%， p<0.0001）。调整基线 LVEF 后，两组之间 LVEF 变化的平均（95% 置信区间）差异为 -3.6%（-1.8% 至 -5.5%，p<0.001）。心脏保护后，1/49 名患者出现 12 个月 LVEF-CTRCD，而常规治疗中这一比例为 6/56 (p=0.075)。心脏保护组的 GLS 在随机分组后 3 个月有所改善，与常规治疗相比变化不大。对于接受蒽环类药物治疗后出现单独 GLS 降低的患者，与常规治疗相比，心脏保护与 12 个月 MRI-LVEF 的更好保存相关。© 作者(s) 2024。由牛津大学出版社代表欧洲心脏病学会出版。

The detection of cancer therapy-related cardiac dysfunction (CTRCD) by reduction of left ventricular ejection fraction (LVEF) during chemotherapy usually triggers the initiation of cardioprotective therapy. This study addressed whether the same approach should be applied to patients with worsening of global longitudinal strain (GLS) without attaining thresholds of LVEF.Strain sUrveillance during Chemotherapy for improving Cardiovascular Outcomes (SUCCOUR-MRI) was a prospective multicentre randomized controlled trial involving 14 sites. Of 355 patients receiving anthracyclines with normal baseline LVEF, 333 patients (age 59±13 years, 79% women) with at least one other CTRCD risk factor, able to undergo magnetic resonance imaging (MRI), GLS and 3D echocardiography were tracked over 12 months. A total of 105 patients (age 59±13 years, 75% women, 69% breast cancer) developing GLS-CTRCD (>12% relative reduction of GLS without a change in LVEF) between cardioprotection with neurohormonal antagonists versus usual care were randomized. The primary endpoint was 12-month change in MRI-LVEF; the secondary endpoint was MRI LVEF-defined CTRCD.During follow-up, 2 patients died and 2 developed heart failure. Most patients were randomized at 3 months (62%). Median doses of angiotensin inhibition/blockade and beta-blockade were 75% and 50% of respective targets; 21 (43%) had side-effects attributed to cardioprotection. Due to a smaller LVEF change from baseline with cardioprotection than usual care (-2.5±5.4% vs -5.6±5.9%, p=0.009), follow-up LVEF was higher after cardioprotection (59±5% vs 55±6%, p<0.0001). After adjustment for baseline LVEF, the mean (95% confidence interval) difference in the change in LVEF between the two groups was -3.6% (-1.8% to -5.5%, p<0.001). After cardioprotection, 1/49 patients developed 12-month LVEF-CTRCD, compared to 6/56 in usual care (p=0.075). GLS improved at 3 months post-randomization in the cardioprotection group, with little change with usual care.In patients with isolated GLS reduction after anthracyclines, cardioprotection is associated with better preservation of 12-month MRI-LVEF compared with usual care.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.