Abstract 12440: Global Longitudinal Strain With 2D-Speckle Tracking Predicts Chemotherapy-related Systolic Dysfunction Independenty of Basal Assessment in Patients With Breast Carcinoma

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Federico Guerra ◽  
Marco Marchesini ◽  
Daniele Contadini ◽  
Alessio Menditto ◽  
Marco Morelli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
High Risk ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Breast Cancer Patients ◽  
2D Speckle Tracking

Introduction: Recent developments in anticancer therapies for breast carcinoma allowed an improvement in patient survival, notwithstanding a parallel increase of cardiovascular morbidity. Systolic dysfunction and heart failure represent a relevant problem in these patients due to insidious onset and the potential irreversible nature of cardiac damage. Therefore, strong and early predictors of chemoteraphy-realted systolic dysfunction are been sought. Hypothesis: To investigate global longitudinal strain (GLS) assessed by 2D-speckle tracking as a potential early marker of systolic dysfunction in chemoteraphy-treated breast cancer patients. Methods: Population include sixty-nine patients, referred to our unit for cardiologic assessment prior to neo-adjuvant or adjuvant chemotherapy for breast cancer. Patients with prior heart failure and atrial fibrillation were excluded. The protocol included a baseline echocolorDoppler and 2D-strain evaluation before the beginning of chemotherapy and subsequent serial controls every 3 months. In patients developing systolic dysfunction, further unscheduled assessment were made at the cardiologist discretion. Results: Nineteen (27.5%) patients were classified as having cardiotoxicity according to CREC and ESMO criteria. ROC curve analysis showed that a 3-month GLS <-16% predicted subsequent development of systolic dysfunction with good sensitivity and specificity (80% and 90% respectively), with a negative predictive value of 92%. Cardiotoxicity occurred in 8 patients at 6 months and in 11 patients within 9 months; among all of those, 84% of patients already showed a GLS <-16% at 3-month, and 100% at 6-month, confirming the early diagnostic potential of GLS. After chemotherapy suspension and introduction of cardioprotective drugs, GLS remained depressed longer than left ventricular ejection fraction (LVEF) over 1-year follow-up. Conclusions: Strain imaging with 2D-speckle tracking allows the identification of patients at high risk of developing systolic dysfunction. An absolute cut-off value of -16% can provide a useful, time-independent clinical tool to improve follow-up management and concentrate resources on high-risk patients.

scholarly journals Clinical outcomes of chemotherapy-induced subclinical left ventricular systolic dysfunction among breast cancer patients detected using echocardiographic global longitudinal strain

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.G.G Manaloto ◽  
M.K Cruz-Tan ◽  
R.H Tiongco ◽  
R.M Jimenez ◽  
G.H Cornelio
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
All Cause Mortality

Abstract Background Echocardiographic global longitudinal strain (GLS) detects early subclinical left ventricular (LV) systolic dysfunction, before the occurrence of a decreased LV ejection fraction. However, our local data is lacking to determine its impact to clinical outcomes. Purpose The study aimed to determine the clinical outcomes of breast cancer patients who developed subclinical LV systolic dysfunction as determined by an abnormal GLS post-chemotherapy. Methods This retrospective cohort study included 99 breast cancer patients who underwent anthracycline and/or HER-2 receptor inhibitor chemotherapy from January 1, 2016 to December 31, 2018 in a single tertiary hospital. Clinical outcomes of all-cause mortality and overt heart failure were compared between those with normal and abnormal GLS post-chemotherapy. Results The prevalence of subclinical LV systolic dysfunction was 18%, wherein 28% of them had subsequent overt heart failure, and 33% expired. Abnormal GLS occurred at a mean 3.5 months (range 1–8 months) after initiation of chemotherapy and at 8 months (range 6–10 months) after the entire chemotherapy sessions. Development into heart failure was observed at a mean of 6.7 months (range 4–12 months) after occurrence of abnormal GLS. Hypertension and age &gt;56 years were determined to be risk factors. Beta-blockers, ACE inhibitors and statins seemed to be non-protective in our cohort. Abnormalities in GLS were observed at a mean dose of 260 mg/m2 of epirubicin, lower than the dose described as high risk in the literature (600 mg/m2 for epirubicin). In trastuzumab, abnormal GLS occurred as early as 1 month after initiation. LVEF had no significant change within 2 months (p=0.56), but was significantly lower within 12 months post-chemotherapy (p=0.005). All-cause mortality was 3-fold higher (RR=3.00; p=0.02), and the risk to develop heart failure was 4 times higher (RR=4.74; p=0.008) in those with abnormal GLS. Conclusion The development of abnormal GLS post-chemotherapy was associated with subsequent development of overt heart failure and increased all-cause mortality. Abnormal GLS occurred at lower doses of epirubicin and as early as 1 month after initiating trastuzumab. We recommend echo surveillance with GLS monitoring beginning &gt;250 mg/m2 with anthracycline (and after 1–2 months of Trastuzumab), and to repeat at 1–2 months and 9–12 months post-chemotherapy. Funding Acknowledgement Type of funding source: None

scholarly journals Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Anna Calleja ◽  
Frédéric Poulin ◽  
Ciril Khorolsky ◽  
Masoud Shariat ◽  
Philippe L. Bedard ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Therapy ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Breast Cancer Patients ◽  
Lv Dysfunction ◽  
Her2 Breast Cancer

Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined.Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity.Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls.Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%,P=0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3%) was seen in 40% (n=12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n=11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant.Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

P697Regional analysis of 3D-derived speckle tracking for the assessment of myocardial deformation in breast cancer patients submitted to anthracycline chemotherapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Coutinho Cruz ◽  
G Portugal ◽  
L Moura-Branco ◽  
A Galrinho ◽  
A T Timoteo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Breast Cancer Patients ◽  
Segmental Analysis ◽  
2D And 3D ◽  
Anthracycline Chemotherapy

Abstract Introduction Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) and 2D left ventricular global longitudinal strain (GLS) is the gold standard in screening for cancer therapeutics-related cardiac dysfunction (CTRCD). Myocardial deformation assessed with 3D speckle tracking is not currently used in this setting, because of the lack of standardization and cut-off values, in spite of a potential for a greater reliability. Methods Prospective study of female breast cancer patients submitted to anthracycline chemotherapy with or without adjuvant immunotherapy and/or radiotherapy who underwent serial monitoring by 2D and 3D transthoracic echocardiography (ETT). Standard ETT measures and 3D-derived volumetric measures were assessed. Speckle tracking was used to estimate 2D-derived GLS – average and 18 segments – and 3D-derived GLS, global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) – 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%. Variables were compared using the t-student paired test and the Wilcoxon sign-rank test, when appropriate. Results 106 patients (mean age 54.6±12.9 years, 33.0% immunotherapy, 16.5% radiotherapy, baseline LVEF 64.5% ± 8.5%, baseline 2D GLS −21.0±2.8) were included. During a mean follow-up of 16.5±9.6 months, an average of 3.9 echocardiographic examinations were performed per patient and 28 patients (26.4%) developed CTRCD. Overall, 3D regional longitudinal strain was determined in 88.9% of the segments analyzed, with lower success rates in the inferobasal (75.0%), the posterobasal (77.7%) and the laterobasal (82.4%) walls. When comparing variables before and during treatment, there was a significant difference in 2D-derived LVEF (64.5 vs. 57.6 p<0.001), 3D-derived LVEF (60.1 vs. 55.7 p 0.002), 2D-derived GLS (−20.6 vs. −18.2 p<0.001), 3D-derived GLS (−13.8 vs. −12.9 p 0.035), 3D-derived GRS (31.9 vs. 33.4 p 0.024), but not in GCS (−14.5 vs. −13.2 p 0.656) and GAS (−21.5 vs. −22.1 p 0.640). Figure 1 shows the segmental analysis of 2D and 3D strain parameters. In 2D GLS, 11 out of 18 segments showed decreased contractility during follow-up (mainly anterior septum and anterior, lateral and inferior walls). In 3D-derived strain parameters, only 3 out 17 for GLS, 2 out of 17 for GCS, 1 out 17 for GRS and none for GAS showed decreased contractility during follow-up. Segmental analysis of 2D and 3D strain Conclusion In this population, there was worsening of 3D GLS and GRS, besides conventional values, such as LVEF and 2D GLS, during anthracycline-based cancer treatment. 3D-derived myocardial deformation parameters show promise in the setting of CTRCD, since 2D and 3D regional strain parameters might shed a light onto the mechanisms of CTRCD, such that subendocardial myocardial fibers seem to be more affected than medial and subepicardial fibers.

Heart failure: risk stratification and follow-up

2016 ◽  
Author(s):  
Marie Moonen ◽  
Nico Van de Veire ◽  
Erwan Donal
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Heart Failure Patients ◽  
Reverse Remodelling ◽  
Lv Ejection Fraction

An increasing number of two- and three-dimensional echocardiographic, Doppler, and speckle imaging-derived parameters and values can be related to prognosis in heart failure with left ventricular (LV) systolic dysfunction. This chapter discusses both conventional and new indices, including their advantages and potential limitations. There is increasing evidence for the use of new indices, including three-dimensional LV ejection fraction and global longitudinal strain. The follow-up and monitoring of heart failure patients using two-dimensional transthoracic echocardiography is also discussed in this chapter, including how to estimate the LV filling pressures and quantify LV reverse remodelling.

scholarly journals P656 Cardiac dysfunction in breast cancer patients treated with anthracyclines: a single-center experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Cardoso Torres ◽  
C Sousa ◽  
J Simoes ◽  
P Maia Araujo ◽  
A Nunes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Cardiac Dysfunction ◽  
Global Longitudinal Strain ◽  
Antihypertensive Drug Therapy ◽  
Breast Cancer Patients ◽  
Single Center

Abstract Introduction Cardiac dysfunction is a well-documented side effect of cancer treatment, with significant morbidity and mortality. Cardio-oncology units play a vital role in the early identification and management of cancer therapy related cardiovascular side effects and provide a multidisciplinary care for cancer patients. Purpose To describe the incidence of cancer treatment related cardiac dysfunction (CTRCD) in a population of breast cancer patients (pts) under chemotherapy in a single center cardio-oncology unit, and to assess its predictors. Methods We retrospectively evaluated 83 women on anthracycline therapy for breast cancer, with or without anti-HER2 therapy, followed-up between January 2017 and July 2018. CTRCD was defined as more than 10% absolute reduction of LV ejection function (LVEF) to below 50%. Pts with &gt;15% relative percentage reduction from baseline Global longitudinal strain (GLS) or with elevation of high-sensitivity Troponin I (hsTI) levels were considered to be at high risk for developing CTRCD and started cardioprotective treatment with an ACE inhibitor/ARB and a beta-blocker, as did pts with confirmed CRTCD. Also, in pts under antihypertensive drug therapy, switching drugs to cardioprotective ones was performed in the index consultation. Follow-up was organized in our cardio-oncology consultation at 0, 3, 6 and 12 months (or more frequently in selected high-risk cases). Interruption of chemotherapy was a joint decision of the oncology and cardiology teams. Results A total of 83 women with a mean age of 49 years (26-76) were included. 4 pts (4.8%) developed CTRCD. 28 pts (33.7%) were considered to be at high risk due to GLS reduction during follow-up and 17 pts (20.5%) were at high risk due to hsTI elevation. From all the baseline characteristics, only basal BNP correlated with CTRCD (p = 0.033). Other characteristics such as age, presence of cardiovascular risk factors and the previously proposed Cardiotoxicity Risk Score (CRS) did not. There was a high percentage of pts (51.8%; n = 43) under cardioprotective drugs. 37% of the pts initiated cardioprotective drugs following cardio-oncology consultation. Chemotherapy was discontinued in only 2 pts (2.4%). Conclusion CTRCD is difficult to predict by baseline clinical characteristics. Monitoring and management of CTRCD by a multidisciplinary cardio-oncology team resulted in a high rate of cardioprotective drugs use and low rate of permanent discontinuation of chemotherapy. Further studies are needed to further analyze the relationship between these two variables.

scholarly journals Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Santoro ◽  
R Soloperto ◽  
O Casciano ◽  
R Esposito ◽  
M Lembo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cancer Therapy ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Longitudinal Function ◽  
Oncologic Patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &lt; 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &gt;15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p &lt; 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p &lt; 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p &lt; 0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. Abstract Figure.

scholarly journals 270 Prediction of congestive state and prognosis in acute and chronic heart failure: the association between NT-proBNP and left atrial strain

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maria Concetta Pastore ◽  
Giulia Elena Mandoli ◽  
Nicolò Ghionzoli ◽  
Flavio D’Ascenzi ◽  
Luna Cavigli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Study Cohort ◽  
Phone Calls

Abstract Aims In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient’s quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular (CV) congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated. The aim of our study was to determine the association between NT-proBNP and PALS in patients acute and chronic HF. Methods and results Patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization. The overall study cohort included 388 patients (172 with chronic HF and 216 with chronic HF). Mean age was 65 ± 12, 37% were female. Most patients had reduced LV systolic function (mean LV ejection fraction = 30 ± 10%; mean LV global longitudinal strain = −8.3 ± 3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF [median (interquartile range) = 6039 (2989–13 535) pg/ml vs. 544 (200–1533) pg/ml] and lower global PALS =10.4 (6.3–16.45)% vs. 15.6 (10.6–21)%. Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (all P &lt; 0.001) and to be a significant predictor of NT-proBNP with linear regression analysis (R2 = 0.2; P &lt; 0.001). During a median follow-up of 1 year, 98 patients reached the combined endpoint (49 all-cause deaths, 16 CV deaths, 62 HF hospitalizations). With ROC curves, both NT-proBNP and global PALS showed to be good predictors of the combined endpoint (AUC = 0.87and 0.82, respectively, Figure 1). Conclusions Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. Both global PALS and NT-proBNP confirmed to be accurate prognostic markers in HF.

Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Santoro ◽  
R Soloperto ◽  
O Casciano ◽  
R Esposito ◽  
F Luciano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cancer Therapy ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Longitudinal Function ◽  
Oncologic Patients

Abstract Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6±11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &lt;50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &gt;15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p&lt;0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p&lt;0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=−0.40, p=0.006) and after TRZ completion (r=−0.62, p&lt;0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. LV and RV strain during cancer therapy Funding Acknowledgement Type of funding source: None

P2460Prospective evaluation of atrial function by 2D Speckle Tracking analysis in HER-2 positive breast cancer patients during Trastuzumab therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Setti ◽  
G Dolci ◽  
C Bergamini ◽  
A Schiavone ◽  
L F Cerrito ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Strain Rate ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Her2 Breast Cancer ◽  
2D Speckle Tracking ◽  
Her 2 ◽  
Over Time

Abstract Background Trastuzumab (TZ) is a key therapy for HER2+ breast cancer (BC) patients, with well known possible negative effect on left ventricular (LV) function. A decrease in LV global longitudinal strain (GLS) has been demonstrated to be a good predictor of subsequent TZ-related cardiotoxicity (CT). Early left atrial (LA) enlargement preceding LV dysfunction has also been documented. Limited data are available about LA function in this setting. Aim To investigate LA function by deformation indexes (strain rate) in BC patients treated with TZ. Methods HER-2 positive BC metastasis-free patients referring to our echo-lab were prospectively recruited. Patients underwent consecutive transthoracic echocardiography before starting TZ and then every 3 months, up to 12. LV volumes, LV ejection fraction (LVEF) with Simpson biplane methods, LA volume and diastolic parameters were measured; 2D-Speckle Tracking analysis was performed and GLS and peak atrial longitudinal strain (PALS) were analyzed using Philips' QLAB software. Different lab tests and clinical data were also collected. Results 64 patients formed the study population. 40 (62.5%) had a complete 12 months follow up (FU). 53 patients (82.8%) were previously treated with anthracyclines. Mean age was 55.05±12.1 years. CT, as defined by current ESC guidelines, occurred in 6 patients (9.3%). Mean GLS was −21.4±2% and mean baseline PALS was 51.1±12%. GLS analysis was feasible in 91% of patients and PALS analysis in 84%, with excellent reproducibility for GLS (intra-observer ICC 0.93, p=0.8; inter-observer ICC 0.83, p=0.7). Even if during FU cardiotoxicity showed a low prevalence, a drop in LVEF over time was anyway documented, with major worsening at 6 months. Our study confirms previous data reporting a trend of decrease in GLS (p for time = 0.06), with an early drop during the first six months of TZ therapy and a subsequent “plateau” phase; we also reported a significant decrease of PALS over time (p for time = 0.008), with a continuous gradual decrease for the whole FU. A significant positive correlation between baseline PALS and LVEF at 6 months follow up was shown (R2 0.2; p=0.006). Similar result was obtained analyzing the correlation between LAVI and LVEF at 6 months (R2 0,19; p=0,02). Conclusion 2D speckle tracking analysis is feasible and adds useful information about LV and LA functional remodeling. Actual recommendations for CT identification are based upon a joint evaluation of LVEF and GLS, but our study demonstrates that significant variations in GLS and PALS can occur independently of development of CT. Moreover baseline PALS and LAVI predict the trend of LVEF at 6 months of FU, time of the major mean LVEF drop documented. The assessment of LA function by deformation indexes (strain rate) could add further information for daily clinical practice, possibly improving the detection of early CT. More studies are needed to further investigate these exploratory data.

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