Value of layer-specific speckle tracking echocardiography for early detection of myocardial injury caused by chemotherapy in breast cancer patients with cardiovascular risk

2021 ◽  
Author(s):  
Ya Tan ◽  
Lijun Wang ◽  
Bo Hu ◽  
Chuang Chen ◽  
Nan Jiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cardiovascular Risk ◽  
Early Detection ◽  
Cancer Patients ◽  
Speckle Tracking ◽  
Myocardial Injury ◽  
Speckle Tracking Echocardiography ◽  
Breast Cancer Patients

scholarly journals 1185 Three-dimensional speckle tracking echocardiography for the global and regional assessment of myocardial deformation in breast cancer patients submitted to anthracyclines

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Coutinho Cruz ◽  
L Moura-Branco ◽  
G Portugal ◽  
A Galrinho ◽  
M Mota-Carmo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Receiver Operating Curve ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Timely Initiation ◽  
Anthracycline Therapy

Abstract Introduction Serial echocardiographic assessment of 2D/3D left ventricular ejection fraction (LVEF) and 2D global longitudinal strain (GLS) is the gold standard for screening for cancer therapeutics-related cardiac dysfunction (CTRCD). Although 3D speckle tracking echocardiography (STE) has several technical advantages, is more reproducible, and has a better correlation to magnetic resonance than 2D STE, it is still not currently used in this setting. We aimed to investigate the usefulness of 3D STE in evaluating left ventricle mechanics and its relation to CTRCD. Methods Prospective study of female breast cancer patients submitted to anthracycline chemotherapy who underwent one transthoracic echocardiography (ETT) before and at least one ETT during/after chemotherapy. Standard ETT parameters and 3D volumetric measurements were assessed. STE was used to estimate 2D GLS – average and 18 segments – and 3D GLS, global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) – average and 17 segments. CTRCD was defined as an absolute decrease in 2D or 3D LVEF >10% to a value <54% or a relative decrease in 2D GLS >15%. Results 105 patients (mean age 53.8 ± 12.5 years, 52.4% immunotherapy, 77.2% radiotherapy, 2.8 echocardiograms/patient) were included. During a mean follow-up of 12.1 months, 24 patients (22.9%) developed CTRCD. During anthracycline therapy, there was a significant worsening of 2D LVEF (65.6 vs. 57.8), 3D LVEF (61.5 vs. 54.4), 2D GLS (-21.1 vs. -18.0), 3D GLS (-15.6 vs. -10.9), 3D GCS (-14.0 vs. -11.0), 3D GRS (42.0 vs. 28.5) and 3D GAS (-27.0 vs. -20.0) [all p <0.001]. More than 73% of patients presented 3D global strain values below the limits of normal during chemotherapy. On 3D strain regional analysis, impaired contractility was observed in the anterior, inferior and septal walls. Logistic regression analysis showed that 3D GRS and 3D GCS were associated with a higher incidence of CTRCD. In the multivariate model, 3D GRS remained the only independent predictor of CTRCD. The receiver operating curve analysis showed a good calibration and discrimination of 3D GCS and 3D GRS in predicting CTRCD with areas under de curve of 0.748 and 0.719, with the optimal cut-off values being 0.342 for GCS and 0.344 for GRS. These variations were observed a median of 45 days and 22.5 days before the diagnosis of CTRCD, respectively. Conclusion 3D strain parameters worsened during anthracycline therapy, with predominant involvement of septal, anterior and inferior walls. Variations of 3D GCS and GRS were predictive of subsequent CTRCD, and thus can be considered an earlier sign of CTRCD, with added value over the currently recommended 2D/3D LVEF and 2D GLS. Routine application of this technique should be considered in order to offer targeted monitoring and timely initiation of cardioprotective treatment.

scholarly journals TWO DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY PREDICTS PRECLINICAL CARDIOTOXICITY IN BREAST CANCER PATIENTS

2014 ◽  
Vol 63 (12) ◽  
pp. A829 ◽  
Author(s):  
Nicole Sandhu ◽  
Jocelyn Spoon ◽  
Joerg Herrmann ◽  
Patricia Pellikka ◽  
Hector R Villarraga
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Two Dimensional ◽  
Breast Cancer Patients

scholarly journals Speckle-tracking echocardiography in 3D mode in assessing the deformation of the myocardium and identifying subclinical cardiotoxicity during chemotherapy in breast cancer patients with arterial hypertension

2020 ◽  
Vol 17 (3) ◽  
pp. 42-47
Author(s):  
Ani A. Avalyan ◽  
Marina A. Saidova ◽  
Elena V. Oshchepkova ◽  
Irina E. Chazova
Keyword(s):  
Breast Cancer ◽  
Arterial Hypertension ◽  
Cancer Patients ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Lv Systolic Function

Aim.To study the possibilities of speckle-tracking echocardiography (STE) in 3D mode in assessing the strain of the myocardium and identifying subclinical cardiotoxicity during anthracycline-containing chemotherapy in breast cancer patients with arterial hypertension. Materials and methods.The study included 47 patients with triple negative breast cancer (BC) with AH and normotension. All patients underwent transthoracic echocardiography with an assessment of the left ventricular (LV) ejection fraction, also used STE in three-dimensional mode with an assessment of global longitudinal (GLS), circular (GCS), radial (GRS) strain and a new strain parameter strain area (GAS). Results.In patients with BC for a more accurate assessment of LV systolic function, it is advisable to use 3D echocardiography. In BC patients with AH, the initial parameters of LV strain were statistically significantly worse than in patients with normotension and further deterioration was observed after chemotherapy. To determine the sensitivity and specificity of the strain parameters from the 3D-STE data, an ROC analysis was performed. The most diagnostically significant parameter of strain, as a marker of cardiotoxicity, was the global area strain (GAS), which with a cut-off value -14.0% showed a sensitivity equal to 81.5% and a specificity of 73.3%, but the value this parameter of LV deformation requires further study. Conclusion.In BC patients with AH and normotension it is advisable to use the STE in 3D mode to analyze the strain and systolic function of the LV during antitumor treatment. The method is promising for identifying subclinical cardiotoxicity, but further research is needed to develop diagnostic criteria.

scholarly journals Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer

2020 ◽  
Vol 17 (6) ◽  
pp. 397-408
Author(s):  
Agneta Månsson Broberg ◽  
Jürgen Geisler ◽  
Suvi Tuohinen ◽  
Tanja Skytta ◽  
Þórdís Jóna Hrafnkelsdóttir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Heart Failure ◽  
Clinical Trials ◽  
Cardiovascular Risk ◽  
Early Detection ◽  
Cancer Patients ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Breast Cancer Patients

Abstract Purpose of Review Long-term survival has increased significantly in breast cancer patients, and cardiovascular side effects are surpassing cancer-related mortality. We summarize risk factors, prevention strategies, detection, and management of cardiotoxicity, with focus on left ventricular dysfunction and heart failure, during breast cancer treatment. Recent Findings Baseline treatment of cardiovascular risk factors is recommended. Anthracycline and trastuzumab treatment constitute a substantial risk of developing cardiotoxicity. There is growing evidence that this can be treated with beta blockers and angiotensin antagonists. Early detection of cardiotoxicity with cardiac imaging and circulating cardiovascular biomarkers is currently evaluated in clinical trials. Chest wall irradiation accelerates atherosclerotic processes and induces fibrosis. Immune checkpoint inhibitors require consideration for surveillance due to a small risk of severe myocarditis. Cyclin-dependent kinases4/6 inhibitors, cyclophosphamide, taxanes, tyrosine kinase inhibitors, and endocrine therapy have a lower-risk profile for cardiotoxicity. Summary Preventive and management strategies to counteract cancer treatment–related left ventricular dysfunction or heart failure in breast cancer patients should include a comprehensive cardiovascular risk assessment and individual clinical evaluation. This should include both patient and treatment-related factors. Further clinical trials especially on early detection, cardioprevention, and management are urgently needed.

Sign in / Sign up

Export Citation Format

Share Document