Three-dimensional speckle-tracking echocardiography for the global and regional assessments of left ventricle myocardial deformation in breast cancer patients treated with anthracyclines

Abstract

Background Assessment of 2D/3D left ventricular ejection fraction (LVEF) and 2D global longitudinal strain (GLS) is the gold standard for diagnosing cancer therapeutics-related cardiac dysfunction (CTRCD). Although 3D speckle-tracking echocardiography (STE) has several advantages, it is not used in this setting. Methods 105 breast cancer patients who underwent serial echocardiographic assessment during anthracycline therapy were included. STE was used to estimate 2D GLS, 3D GLS, 3D global circumferential strain (GCS), 3D global radial strain (GRS), and 3D global area strain (GAS). CTRCD was defined as an absolute decrease in 2D/3D LVEF > 10% to a value < 54% or a relative decrease in 2D GLS > 15%. Results 24 patients developed CTRCD. There was a significant worsening of all 3D strain parameters during chemotherapy. 3D strain regional analysis showed impaired contractility in the anterior, inferior, and septal walls. Variations of 3D GRS and 3D GCS were associated with a higher incidence of CTRCD and the variation of 3D GRS was an independent predictor of CTRCD. Variations of 3D GCS and 3D GRS had a good discrimination for predicting CTRCD, with optimal cutoff values of − 34.2% for 3D GCS and − 34.4% for 3D GRS. These variations were observed 45 and 23 days before the diagnosis of CTRCD, respectively. Conclusion Variations of 3D strain parameters were predictive of and preceded CTRCD, and thus have added value over currently recommended 2D/3D LVEF and 2D GLS. Routine application of this technique should be considered to offer targeted monitoring and timely initiation of cardioprotective treatment.

Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients

“…The use of LV PSL in this population demonstrates that LV mechanics are affected in all MW components during oncology treatment. This is concordant with the evidence obtained with 2D LVEF and 2D GLS [ 47 ], as well as with more recent reports of 3D STE [ 48 , 49 , 50 ].…”

Evaluation of Cardiac Function before and after PAD Regimen in Patients with Multiple Myeloma by Three-Dimensional Speckle Tracking Imaging

“…The slight segmental motion abnormality of the ventricle can be detected relatively earlier, which is more suitable for the monitoring and evaluation of the early changes of cardiac function [ 24 – 28 ]. Coutinho Cruz et al [ 29 ] analyzed 105 patients with breast cancer who were evaluated by echocardiography during anthracycline treatment. The results showed that a total of 24 patients had dysfunctional care in the treatment of cancer.…”

Role of myocardial strain imaging in surveillance and management of cancer therapeutics‐related cardiac dysfunction: A systematic review

“…Initially, 2759 citations were screened at the title/abstract level and 59 full texts were manually reviewed for relevant articles. This search resulted in 31 relevant publications (Table 1) 6‐36 and excluded 28 publications that did not meet selection criteria. The criteria for selecting studies was the use of GLS to predict CTRCD defined according to ASE and EACVI criteria as LVEF decrement of >10% to a value <53% 2 during long‐term clinical follow‐up after chemotherapy.…”

“…33 Predictive power for CTRCD may also be enhanced by the addition of 3D strain parameters to 2DSTE. 11 Likewise, integration of clinical heart failure risk factors with echocardiographic variables (to include strain) has shown superior receiver-operating characteristics (c = 0.9629) over GLS or clinical risk factors alone. 23…”