Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment

Abstract

BackgroundThe high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes.ObjectivesTo assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early.MethodsProspective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05.ResultsOf 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0).ConclusionThe 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.

Cardiotoxicity associated with immune checkpoint inhibitors: A retrospective analysis of patients at an academic tertiary care center

“…Previous studies have also explored early detection of chemotherapy-induced changes in cardiac function using the echocardiographic measures of ejection fraction and/or global longitudinal strain. [25][26][27][28] In the subset of patients in our study who developed cardiotoxicity and had pre-and posttreatment left ventricular ejection fraction (LVEF) and GLS data available, a GLS decline was observed in the absence of a meaningful decrease in LVEF. This small dataset is congruent with the ndings from Awadalla et al, who demonstrated GLS decreases were lower in patients with ICI induced myocarditis compared to control patients and was associated with the development of major adverse cardiovascular events.…”

Breast Radiotherapy and Early Adverse Cardiac Effects. The Role of Serum Biomarkers and Strain Echocardiography

“…Αctually, Stoodley et al found reduced post-chemotherapy strain parameters in 52 women with breast cancer; the capacity of strain imaging to predict early cardiotoxicity was also confirmed by Sawaya et al one year later (47,48). More recent studies also supported the decrease of strain parameters after chemotherapy, hence, declaring the potential ability of this method to predict early dysfunction of the heart tissue (49,50).…”

Cardiotoxicity associated with immune checkpoint inhibitors: A retrospective analysis of patients at an academic tertiary care center

“…GLS, which detects early changes in myocardial contractile function, has been used to monitor for cardiotoxicity caused by antineoplastic agents in patients receiving anthracyclines and/or trastuzumab. [21][22][23] GLS has been utilized for early screening of cardiomyopathy and/or heart failure in patients receiving anti-neoplastic agents. There are limited GLS data on patients receiving ICIs.…”