Echocardiographic Assessment of Cardiotoxic Effects of Cancer Therapy

Abstract

Patients with cancer can present with difficult management issues, as the medicine can sometimes cause sequelae destructive to healthy tissue. As this population lives longer, cardiotoxic effects are beginning to emerge, but the early recognition of this signal can prove difficult, with too late a recognition leading to lifelong cardiac impairment and dysfunction. Cardio-oncology can bridge this difficulty, and echocardiography and its newer imaging abilities are proving efficacious in this population. This article will address common sequelae of cardiotoxic treatment regimens and offer recommendations for echocardiographic surveillance. We recommend echocardiography, preferably three-dimensional and strain imaging, to monitor for cardiotoxic myocardial effects before, during, and after chemotherapy with cardiotoxic drug regimens, particularly anthracycline derivatives. A reduction in left ventricular (LV) global longitudinal strain in all patients, or reduction in LV global circumferential strain or global radial strain in patients at intermediate to high risk for cardiotoxicity, despite normal LV ejection fraction warrants a clinical assessment on the benefits of continuing cardiotoxic chemotherapeutic agents. Lifelong surveillance using echocardiography for cardiotoxicity and radiation-related valvular, pericardial, and coronary artery disease is prudent.

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).…”

Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of Cardio-Oncology—Part 1: acute coronary syndromes and acute pericardial diseases

“…45 Effusions can also be paraneoplastic or caused by specific cancer treatments, infections in immunocompromised patients, as well as post-operatively after mediastinal surgery. 46,47 Acute pericardial effusions may also follow radiation therapy especially after chemoradiotherapy for lung and oesophageal cancers. 48,49 Pericardial effusions have been reported with different cancer therapies (Table 1).…”

Speckle-Tracking Echocardiography in Cardio-Oncology and Beyond

“…In contrast, in patients with restrictive cardiomyopathy, the longitudinal strain is reduced. 70,71 In addition, detailed echocardiographic analysis of 3-layer longitudinal and circumferential strain and twist angle shows promise for helping to distinguish between various perimyocardial inflammatory syndromes, ranging from predominantly pericarditis to predominantly myocarditis. 72…”