Background: Literature suggests that left ventricular global longitudinal strain (LV-GLS) on speckle echocardiography has the potential to predict cardiotoxicity amongst breast cancer patients receiving chemotherapy such as anthracycline, taxane, cyclophosphamide, and trastuzumab. Our study aimed to collect evidence for the prognostic value of LV-GLS for predicting chemotherapy-induced cardiotoxicity in breast cancer patients.
Methods:A detailed search of the PubMed, Google Scholar, Cochrane Library, and Scopus databases was conducted for published articles up to August 31, 2022. In our meta-analysis, we looked at 13 studies with a total of 1007 breast cancer patients getting chemotherapy that looked at the predictive value of GLS.Results: Absolute GLS change during treatment showed a pooled sensitivity of 84% (95% CI 74% to 91%) and a pooled specificity of 77% (95% CI 68% to 84%). For a relative change in GLS, we observed a pooled sensitivity of 76% (95% CI 56% to 89%) and a pooled specificity of 83% (95% CI 73% to 90%). For an absolute change in GLS, we observed a positive likelihood ratio (LR), and the negative LR was 4 and .21. Summary receiver operating characteristics curve with prediction and confidence intervals represents a promising summary area under the curve (sAUC) of .88, 95% CI ranges from .85 to .91 for absolute change in GLS, as well as for relative change (sAUC, .87, 95% CI .84 to .90).
Conclusion:Our results demonstrated an estimation of LV-GLS after the beginning of required chemotherapy, including anthracyclines and trastuzumab, had a promising prognostic value for predicting the likelihood of cancer therapeutics-related cardiac dysfunction. To confirm our findings, well-designed prospective adequately powered diagnostic randomised trials are necessary.
We assessed the effects of upstream administration of the glycoprotein IIb/IIIa inhibitor tirofiban before percutaneous coronary intervention (PCI) on spontaneous reperfusion (SR) of infarct-related artery (IRA) and the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The incidence of SR of the IRA was significantly higher in the tirofiban group than in the no-tirofiban group (141 [36.5%] vs 21 [17.2%], P < .001). By multivariate logistic regression analysis, use of tirofiban (odds ratio 2.32, 95% confidence interval 1.25-4.31, P = .008) independently predicted the occurrence of SR. Kaplan-Meier survival analysis demonstrated that major adverse cardiovascular event-free survival was significantly higher in patients treated with tirofiban than in patients without tirofiban at 30-day (log rank = 11.65, P = .001) and 90-day follow-up (log rank = 16.79, P < .001). Upstream administration of tirofiban is significantly associated with increased SR of the IRA and favorable clinical prognosis in patients undergoing PCI for STEMI.
Background: Literature suggests that left ventricular global
longitudinal strain (LV-GLS) on speckle echocardiography has the
potential to predict cardiotoxicity amongst breast cancer patients
receiving chemotherapy such as anthracycline, taxane, cyclophosphamide,
and trastuzumab. Our study aimed to collect evidence for the prognostic
value of LV-GLS for predicting chemotherapy-induced cardiotoxicity in
breast cancer patients. Methods: A detailed search of the
PubMed, Google Scholar, Cochrane Library, and Scopus databases was
conducted for published articles up to August 31, 2022. In our
meta-analysis, we looked at 13 studies with a total of 1007 breast
cancer patients getting chemotherapy that looked at the predictive value
of GLS. Results: Absolute GLS change during treatment showed a
pooled sensitivity of 84% (95% CI: 74% to 91%) and a pooled
specificity of 77% (95% CI: 68% to 84%). For a relative change in
GLS, we observed a pooled sensitivity of 76% (95% CI: 56% to 89%)
and a pooled specificity of 83% (95% CI: 73% to 90%). For an
absolute change in GLS, we observed a positive likelihood ratio (LR),
and the negative LR was 4 and 0.21. SROC with prediction and confidence
intervals represents a promising summary area under the curve (sAUC) of
0.88, 95% CI ranges from 0.85 to 0.91 for absolute change in GLS, as
well as for relative change (sAUC, 0.87, 95% CI 0.84 to 0.90).
Conclusion: Our results demonstrated an estimation of LV-GLS
after the beginning of required chemotherapy, including anthracyclines
and trastuzumab, had a promising prognostic value for predicting the
likelihood of CTRCD. To confirm our findings, well-designed prospective
adequately powered diagnostic randomised trials are necessary.
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