Prognostic value of left ventricular global longitudinal strain on speckle echocardiography for predicting chemotherapy‐induced cardiotoxicity in breast cancer patients: A systematic review and meta‐analysis

Abstract

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.

Left atrial strain as a potential parameter to detect cancer therapy‐related cardiac dysfunction: An editorial commentary and systematic review

“…asymptomatic episodes of AF that could lead to a cardioembolic stroke. Therefore, according to previous studies on the potential use of LA strain to predict the risk of AF [18][19][20][21][22] and the novel findings of the study by Li et al, 5 along with other previous studies (see a systematic review in Table 1), [6][7][8][9][10][11][12][13][14][15][16][17] it is possible to state that LA strain is a promising parameter in the setting of CTRCD, which warrants further validation.…”

“…5 In this respect, the authors in a study of 80 patients treated with anthracyclines detected that a relative decline of LA strain > 19% had a sensitivity of 71.4% and specificity of 87.9% for detecting CTRCD. 5 However, the sample size analyzed was small, and the prognostic role of LA dysfunction or abnormal LA strain (i.e.,…”

“…1 In this regard, a relative decline of GLS > 15% despite an LVEF > 50% indicates a mild CTRCD, 1 as it has been stated in the 2022 ESC Guidelines for CTRCD and validated in previous studies. [1][2][3][4] Notwithstanding this, little is known about the role of other strain parameters, such as left atrial reservoir strain (LA strain), for detecting CTRCD.…”

“…[18][19][20][21][22] By the way, many patients with cancer also have CV risk factors such as arterial hypertension or diabetes and preserved LVEF. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Hence, it is worth noting that using LA strain to predict the risk of AF in the context of CTRCD may be of high clinical relevance. In effect, an abnormal LA strain indicates a higher risk for a new-onset AF, [18][19][20][21][22] thereby justifying the need for more intensive cardiac monitoring, such as a 5−7 day ECG Holter, rather than just clinical surveillance, to detect…”

“…LA strain < 23%) before or after chemotherapy was not analyzed in this study. 5 Hence, while the findings of this study are promising and in agreement with previous studies (see Table 1, which shows a systematic review), [5][6][7][8][9][10][11][12][13][14][15][16][17] further larger studies should validate these results by analyzing the clinical relevance of an abnormal LA strain before and after chemotherapy and by validating the sensitivity and specificity of a relative decline of LA strain (> 10%, 15%, 20%, and 25%) to detect CTRCD.…”