## 4 Discussion
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline \multirow{2}{*}{**Parameter**} & **Survivors** & **Non-Survivors** & \multirow{2}{*}{**Cut-off**} & **Sensibility** & **Specificity** & \multirow{2}{*}{**AUC**} & \multirow{2}{*}{_P_} \\  & **(n = 27)** & **(n = 20)** & & & & & \\ \hline LVEF (\%) & \(60.81\pm 3.03\) & \(57.85\pm 4.45\) & \(\leq\)57 & 50 & 88.9 & 0.740 & 0.0014 \\ Left E/A ratio & \(0.97\pm 0.19\) & \(1.29\pm 0.85\) & \(\downarrow\)1.16 & 45 & 96.3 & 0.661 & 0.07 \\ Left E/e ratio & \(9.55\pm 4.11\) & \(10.72\pm 5.50\) & \(\downarrow\)7.87 & 70 & 51.8 & 0.589 & 029 \\ Left E1T index & \(0.46\pm 0.12\) & \(0.49\pm 0.13\) & \(\downarrow\)0.42 & 65 & 55.62 & 0.47 \\ TAPSE (mm) & \(23.08\pm 4.11\) & \(22.29\pm 4.12\) & \(\downarrow\)18 & 20 & 96.3 & 0.534 & 0.69 \\ Right E/A ratio & \(0.99\pm 0.27\) & \(1.12\pm 0.45\) & \(\downarrow\)0.91 & 60 & 66.7 & 0.561 & 0.50 \\ Right E/e ratio & \(4.84\pm 1.58\) & \(4.40\pm 1.38\) & \(\leq\)4.52 & 70 & 59.3 & 0.600 & 0.24 \\ Right TEI index & \(0.43\pm 0.14\) & \(0.44\pm 0.10\) & \(\downarrow\)0.44 & 55 & 63 & 0.547 & 0.58 \\ FMD (\%) & \(9.71\pm 3.53\) & \(6.13\pm 2.62\) & \(\leq\)5.8 & 45 & 96.3 & 0.756 & 0.0003 \\ APAO (mm) & \(1.61\pm 0.29\) & \(1.54\pm 0.23\) & \(\leq\)1.59 & 70 & 55.6 & 0.570 & 0.40 \\ Mean C-MMT (mm) & \(0.68\pm 0.13\) & \(0.71\pm 0.17\) & \(\downarrow\)0.83 & 25 & 92.6 & 0.533 & 0.70 \\ \hline \hline \end{tabular}  
* **Abbreviations:** APAO: micro-posterior diameter of the inframan abdominal aorta; AUC: area under the curve; FMD: flow-mediated vasodilation; LVEF: left ventricle ejection fraction; mean C-IMT: mean common carotid intimima-media thickness; TAPSE: tricuspid annular plane systolic excursion.  
\end{table} 
Table 3: Echocardiographic and vascular predictors of all-cause mortality. by these drugs are different: apoptosis of cardiomyocytesocytes, deregulation of mitochondrial mitochondrial pathways, and increasing the production of oxygen free radicals [24; 25]. Indeed, no study evaluated the impact of baseline evaluation of the LVEF on the prognoses of patients with cancer. Our study is the first one dealing with the long-term (6 years) impact of left ventricle function on the prognoses of patients with gynecological cancers. We demonstrated that an LVEF \(\leq 57\%\) was able to detect patients' mortality with a sensibility of 50%, specificity of 88.9%, and AUC of 0.740. Multivariate Cox regression analysis confirmed the independent role of the LVEF as an all-cause mortality predictor. Parallel to that, right ventricle function, evaluated by means of TAPSE, seemed to be able to predict mortality in gynecological cancers. The consequences of this study are mainly related to the additional need for a comprehensive baseline evaluation of patients with gynecological cancers by means of echocardiography. [PERSON] et al. [26] demonstrated the cost-effectiveness of baseline evaluation of left ventricle function in patients with cancer who would undergo chemotherapy. The echocardiographic screening allows for the opportunity to detect cardiac impairment before the beginning of the anti-proliferative therapy and, in parallel, to ideally identify those individuals with apparently normal LVEFs, but who are prone to suffer reduced survival in the long term after treatment of their cancer. A retrospective study on 482 patients with breast cancer who underwent LVEF evaluation before anthracycline-based chemotherapy administration demonstrated the change in chemotherapy regimen in relation to their baseline LVEF values [27]. [PERSON] et al. [28] pointed out that most patients with breast cancer who developed cardiac events did not undergo baseline evaluation of their LVEFs before chemotherapy administration. Nevertheless, a recent meta-analysis from [PERSON] et al. [29] reduced the value of the baseline evaluation of echocardiography and the LVEF in the management of patients with breast cancer, although further structured trials should be planned. Endothelial dysfunction is related to adverse cardiovascular event mortality [30; 31].