Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy for the prediction of subsequent cardiotoxicity

Charbonnel, C.; Convers-Domart, R.; Rigaudeau, Sophie; Taksin, Anne‐Laure; Baron, N.; Lambert, Juliette; Ghez, Stéphanie; Farhat, H.; Rousselot, Philippe; Livarek, B.

doi:10.1016/j.ancard.2016.09.033

Cited by 33 publications

(39 citation statements)

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“… In our study, LVEF was significantly reduced when the cumulative dose of anthracycline was at 320 mg/m 2 . Previous studies on the sensitivity of GLS in monitoring anthracycline‐induced myocardial damage showed that when the average cumulative dose was 60 mg/m 2 , GLS did not decrease significantly, and when the average cumulative dose was 266 mg/m 2 (200–298 mg/m 2 ), GLS decreased significantly . The results of our study showed that when the cumulative dosage of anthracycline was <160 mg/m 2 , GLS showed a significant decrease.…”

Section: Discussioncontrasting

confidence: 41%

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anqi

Zhang

et al. 2019

Echocardiography

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Background Anthracycline‐related cardiotoxicity has a poor prognosis; therefore, early detection of any change in LV function is critical. Objective The aim of this study was to evaluate the two‐dimensional speckle tracking technique for the early detection of cardiac toxicity after low‐dose anthracycline chemotherapy in the Chinese population. Methods Forty breast cancer patients were treated by chemotherapy using anthracycline for 4–6 cycles. Patients were examined by echocardiography before chemotherapy (T0) and after the second (T2), fourth (T4), and sixth (T6) cycle. LV ejection fraction (LVEF), LV global longitudinal strain (GLS) and endocardium, mid‐myocardium, and epicardium global longitudinal strain (GLS‐Endo, GLS‐Mid, and GLS‐Epi). Additionally, global circumferential strain (GCS), RV global longitudinal strain (RVGLS), and LA global longitudinal strain (LAGLS) were evaluated. Results Left ventricular ejection fraction was significantly reduced at T4 (P < 0.05). Compared with T0, GLS, GLS‐Endo, GLS‐Mid, and GLS‐Epi were significantly reduced at T2, T4, and T6 (P < 0.05 for all), the apical septum wall (AS) was also reduced significantly at T2 (P < 0.05), and the apical anterior wall (AA) and the basal anterior wall (BA) longitudinal strains were significantly reduced at T4 (P < 0.05). GCS, RVGLS, and LAGLS were not significantly changed after treatment (P > 0.05). Conclusions LV stratified strains and strain of the segments supplied by the left anterior descending coronary artery are more sensitive to the cardiac toxicity of anthracycline.

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Section: Discussioncontrasting

confidence: 41%

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anqi

Zhang

et al. 2019

Echocardiography

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“…Advanced imaging techniques such as echocardiography-derived measures of global longitudinal strain and CMRI may detect early stages of cardiac dysfunction and predict future ARLVD. 57,58 For detailed recommendations on imaging, please refer to the joint American and European recommendations. 12 Cardiac biomarkers are currently being investigated for their role in predicting ARLVD and to identify patients who could benefit from cardioprotective therapy.…”

Section: Assessment Of Cardiac Function Before and During Treatmentmentioning

confidence: 99%

Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper

et al. 2020

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The incidence of acute myeloid leukemia (AML) increases with age. Intensive induction chemotherapy containing cytarabine and an anthracycline has been part of the upfront and salvage treatment of AML for decades. Anthracyclines are associated with a significant risk of cardiotoxicity (especially anthracycline-related left ventricular dysfunction [ARLVD]). In the older adult population, the higher prevalence of cardiac comorbidities and risk factors may further increase the risk of ARLVD. In this article of the Young International Society of Geriatric Oncology group, we review the prevalence of ARLVD in patients with AML and factors predisposing to ARLVD, focusing on older adults when possible. In addition, we review the assessment of cardiac function and management of ARLVD during and after treatment. It is worth noting that only a minority of clinical trials focus on alternative treatment strategies in patients with mildly declined left ventricular ejection fraction or at a high risk for ARLVD. The limited evidence for preventive strategies to ameliorate ARLVD and alternative strategies to anthracycline use in the setting of cardiac comorbidities are discussed. Based on extrapolation of findings from younger adults and nonrandomized trials, we recommend a comprehensive baseline evaluation of cardiac function by imaging, cardiac risk factors, and symptoms to risk stratify for ARLVD. Anthracyclines remain an appropriate choice for induction although careful risk-stratification based on cardiac disease, risk factors, and predicted chemotherapy-response are warranted. In case of declined left ventricular ejection fraction, alternative strategies should be considered.

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“…In particular, left ventricular ejection fraction (EF), the ratio of left ventricular end systolic and end diastolic volume, is one of the most important metrics of cardiac function, as it identifies patients who are eligible for life prolonging therapies 8,12 . However, there can be significant interobserver variability as well as inter-modality discordance based on methodology and modality 2,5,6,[12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

“…Our end-to-end approach generates beat and clip level predictions of ejection fraction as well as segmentation of the left ventricle throughout the cardiac cycle for visual interpretation of the modeling results. In settings such as between chemotherapy sessions, after a heart transplant, and with the initiation of heart failure therapy, early detection of change in cardiac function significantly affect clinical care2,3 .…”

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confidence: 99%

Interpretable AI for beat-to-beat cardiac function assessment

Ouyang

Ghorbani

et al. 2019

Preprint

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Accurate assessment of cardiac function is crucial for diagnosing cardiovascular disease, screening for cardiotoxicity and deciding clinical management in patients with critical illness. However human assessment of cardiac function focuses on a limited sampling of cardiac cycles and has significant interobserver variability despite years of training. To overcome this challenge, we present the first beat-to-beat deep learning algorithm that surpasses human expert performance in the critical tasks of segmenting the left ventricle, estimating ejection fraction, and assessing cardiomyopathy. Trained on echocardiogram videos, our model accurately segments the left ventricle with a Dice Similarity Coefficient of 0.92, predicts ejection fraction with mean absolute error of 4.1%, and reliably classifies heart failure with reduced ejection fraction (AUC of 0.97). Prospective evaluation with repeated human measurements confirms that our model has less variance than experts. By leveraging information across multiple cardiac cycles, our model can identify subtle changes in ejection fraction, is more reproducible than human evaluation, and lays the foundation for precise diagnosis of cardiovascular disease. As a new resource to promote further innovation, we also make publicly available one of the largest medical video dataset of over 10,000 annotated echocardiograms.

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Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy for the prediction of subsequent cardiotoxicity

Cited by 33 publications

References 0 publications

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper

Interpretable AI for beat-to-beat cardiac function assessment

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