Potential Role of Global Longitudinal Strain in Cardiac and Oncological Patients Undergoing Cardio-Oncology Rehabilitation (CORE)

Abstract

Although shown to be effective in improving survival and quality of life in patients with cancer, some treatments are well-known causes of cardiotoxicity, such as anthracyclines, monoclonal antibodies against human epidermal growth factor receptor 2 (HER2) and radiotherapy. To prevent cardiovascular disease (CVD) in patients living with cancer, cardiologists and oncologists promoted the development of cardio-oncology, an interdisciplinary field which aims to further improving life expectancy in these patients. Cardio-oncology rehabilitation (CORE), through correction of risk factors, prescription of drug therapies and structured exercise programs, tries to improve symptoms, quality of life, cardiorespiratory fitness (CRF) and survival in patients with cancer. Different imaging modalities can be used to evaluate the real effectiveness of exercise training on cardiac function. Among these, the global longitudinal strain (GLS) has recently aroused interest, thanks to its high sensitivity and specificity for cardiac dysfunction detection due to advanced ultrasound programs. This review summarizes the evidence on the usefulness of GLS in patients with cancer undergoing cardiac rehabilitation programs.

Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

“…Advanced echocardiography could add key information in this setting with speckle-tracking-echocardiography-derived parameters. Currently, studies on the role of GLS [13][14][15][16][17][18][19] in evaluating the effect of exercise training on myocardial function have shown conflicting data. Moreover, the method is affected by various limitations, such as load dependence and lack of information on metabolic demand.…”

“…Several studies documented the positive effect of exercise training on GLS, specifically in patients with arterial hypertension [13,14], recent myocardial infarction [15], or recent ST-segment elevation myocardial infarction (STEMI) and LV ejection fraction > 45% [16]. However, other studies showed conflicting data on the improvement in GLS due to the training program [17,18], as well as in oncological patients undergoing cardio-oncology rehabilitation, suggesting the need for further investigations [19]. On the other hand, noninvasive MW has been poorly studied in the field of cardiac rehabilitation.…”

The Role of the Cardiac Biomarkers in the Renal Cell Carcinoma Multidisciplinary Management

“…The 15% threshold comparing to baseline was reported to maximise specificity and minimise overdiagnosis of oncologic toxicity CV diseases and guide cardioprotective therapy [40,59]. The potential role of GLS in cardiac and oncological patients undergoing cardio-oncology rehabilitation is under analysis [60]. Researchers recommended using the same vendor to analyse GLS during cancer treatment to compare values over time more accurately [61].…”