Abstract 14645: Three Dimensional Ejection Fraction is More Strongly Determined by Strain Than by Torsion in a Cohort of Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gaurav Gulati ◽  
Benjamin French ◽  
Kathleen W Zhang ◽  
Hari K Narayan ◽  
Akinyemi Bajulaiye ◽  
...  

Introduction: Anthracycline cardiotoxicity affects approximately 10-20% of treated individuals, representing a significant health burden. Three dimensional (3D) echocardiographic measures of myocardial mechanics have the potential to improve our understanding of the functional changes that occur with anthracyclines, and may play an important role in cardiotoxicity risk prediction. Our objective was to define the relationships between 3D myocardial deformation parameters and left ventricular ejection fraction (LVEF) in a longitudinal, prospective cohort of patients with breast cancer. Methods: We performed 3D echocardiograms at standardized intervals in a longitudinal cohort of women with breast cancer undergoing doxorubicin therapy with or without trastuzumab. We acquired all 3D images at a minimum of 22 frames per second and excluded from analysis all images that had poor tracking of greater than 3 myocardial segments, dropout of the apex, or stitch artifact. Two readers used a vendor-independent analysis platform (TomTec Cardiac Performance Analyses, Unterschleissheim, Germany) to measure 3D LVEF and the following 3D deformation parameters: principal strain, global longitudinal strain (GLS), global circumferential strain (GCS), and left ventricular torsion. Spearman correlation analyses were performed to understand the relationships amongst these parameters. Results: We analyzed 270 total echocardiograms from 87 women (mean age 49). Conventional 3D strain parameters were highly correlated with 3D LVEF (principal strain, r=-0.95, p<0.001; GLS, r=-0.85, p<0.001; GCS r=-0.97, p<0.001). In contrast, left ventricular torsion was only modestly correlated with 3D LVEF (r=0.51, p<0.001). Conclusions: Three dimensional principal strain, GLS, and GCS were all strongly correlated with 3D LVEF. However, left ventricular torsion was only weakly correlated to LVEF, suggesting that LVEF is determined less by torsion than by 3D strain. With further study, 3D strain may play an important role in chemotherapy cardiotoxicity risk prediction.

2017 ◽  
Vol 20 (1) ◽  
pp. 026 ◽  
Author(s):  
Nan Cheng ◽  
Liuquan Cheng ◽  
Rong Wang ◽  
Lin Zhang ◽  
Changqing Gao

Objective: The aim of this study was to quantify left ventricular torsion by newly applied cardiovascular magnetic resonance feature tracking (CMR-FT), and to evaluate the clinical value of the ventricular torsion as a sensitive indicator of cardiac function by comparison of preoperative and postoperative torsion.Methods: A total of 54 volunteers and 36 patients with previous myocardial infarction (MI) and LV ejection fraction (EF) between 30%-50% were screened preoperatively or postoperatively by MRI. The patients’ short axis views of the whole heart were acquired, and all patients had a scar area >75% in at least one of the anterior or inferior segments. Their apical and basal rotation values were analyzed by feature tracking, and the correlation analysis was performed for the improvement of LV torsion and ejection fraction after CABG. The intra- and inter-observer reliabilities of torsion measured by CMR-FT were assessed.Results: In normal hearts, the apex rotated counterclockwise in the systolic period with the peak rotation as 10.2 ± 4.8°, and the base rotated clockwise as the peak value was 7.0 ± 3.3°. There was a timing hiatus between the apex and base untwisting, during which period the heart recoils and its suction sets the stage for the following rapid filling period. The postoperative torsion and rotation significantly improved compared with preoperative ones. However, the traditional indicator of cardiac function, ejection fraction, didn’t show significant improvement.Conclusion: Left ventricular torsion derived from CMR-FT, which does not require specialized CMR sequences, was sensitive to patients with low ejection fraction whose cardiac function significantly improved after CABG. The rapid acquisition of this measurement has potential for the assessment of cardiac function in clinical practice. 


Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hosakote M Nagaraj ◽  
Thomas S Denney ◽  
Steven G Lloyd ◽  
David Calhoun ◽  
Inmaculada Aban ◽  
...  

Background: Muscle fibers are arranged in a spiral network and are connected by extracellular matrix (ECM). LV torsion is increased in the pressure overloaded heart where there is an increase in ECM. However, torsion and its relation to ECM have not been systematically studied in the volume overloaded heart. Hypothesis: The volume overloaded heart has a decrease in LV torsion due a loss of ECM. Methods: Primary mitral regurgitation (MR) (n=29), resistant hypertension (HTN) (n=77) and normal volunteers (NL) (n±37) were studied. Comprehensive cardiac magnetic resonance imaging (MRI) with tissue tagging was performed and analyzed using three-dimensional data set. Torsion was computed by fitting a B-spline deformation model in prolate-spheroidal coordinates to the tag line data. A subset of MR subjects had LV collagen assessed by picric acid Sirius red from biopsy samples taken at the time of surgery. Results: LV ejection fraction was 65% in MR and 70% in HTN. MR demonstrated eccentric remodeling and HTN demonstrated concentric remodeling. HTN had significantly higher torsion angle and systolic twist compared to NL and MR. This was associated with a simultaneous decrease in longitudinal strain. In contrast, MR patients had similar torsion indices, circumferential and longitudinal strains compared to NL. LV biopsy in MR demonstrated a decrease in interstitial collagen compared to NL. Conclusions: As opposed to the pure volume overloaded heart, LV torsional forces are increased in the pressure overloaded heart. This difference may be related to a rearrangement of the laminar structure due to a differential effect on ECM in the volume overloaded versus the pressure overloaded heart.


2017 ◽  
Vol 81 (4) ◽  
pp. 529-536 ◽  
Author(s):  
Krunoslav Michael Sveric ◽  
Stefan Ulbrich ◽  
Mohamed Rady ◽  
Tobias Ruf ◽  
Heda Kvakan ◽  
...  

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Posch ◽  
T Glantschnig ◽  
S Firla ◽  
M Smolle ◽  
M Balic ◽  
...  

Abstract Background Monitoring left-ventricular ejection fraction (LVEF) is a routinely-practiced strategy to survey patients with breast cancer (BC) towards cardiotoxic treatment effects. However, whether the LVEF as a single measurement or as a trajectory over time is truly sufficient to identify patients at high risk for cardiotoxicity is currently debated. Purpose To quantify the prognostic impact of LVEF and its change over time for predicting cardiotoxicity in women with HER2+ early BC. Methods We analyzed 1,136 echocardiography reports from 185 HER2+ early BC patients treated with trastuzumab ± chemoimmunoendocrine therapy in the neoadjuvant/adjuvant setting (Table 1). Cardiotoxicity was defined as a 10% decline in LVEF below 50%. Results Median baseline LVEF was 64% (25th-75th percentile: 60–69). Nineteen patients (10%) experienced cardiotoxicity (asymptomatic n=12, symptomatic n=7, during treatment n=19, treatment modification/termination n=14), Median time to cardiotoxicity was 6.7 months, and median LVEF decline in patients with cardiotoxicity was 18%. One-year cardiotoxicity risk was 7.6% in the 35 patients with a baseline LVEF≥60% and 24.5% in the 150 patients with a baseline LVEF<60% (Hazard Ratio (HR)=3.45, 95% CI: 1.35–8.75, Figure 1). During treatment, LVEF declined significantly faster in patients who developed cardiotoxicity than in patients without cardiotoxicity (1.3%/month vs. 0.1%/month, p<0.0001). A higher rate of LVEF decrease predicted for higher cardiotoxicity risk (HR per 0.1%/month higher LVEF decrease/month=2.50, 95% CI: 1.31–4.76, p=0.005), and cardiotoxicity risk increased by a factor of 1.7 per 5% absolute LVEF decline from baseline to first follow-up (HR=1.70, 95% CI: 1.30–2.38, p<0.0001). Thirty-six patients (19%) developed an LVEF decline of at least 5% from baseline to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and a baseline LVEF≥60% (n=117), 15.7% in those without an early LVEF decline and a baseline LVEF<60% (n=65), and 66.7% in those with an early LVEF decline and a baseline LVEF<60% (n=3), respectively (log-rank p<0.0001). Table 1. Baseline characteristics Age (years, median [IQR]) 55 [49–65] Estrogen receptor positive (n, %) 124 (67%) Neoadjuvant setting (n, %) 103 (56%) Figure 1. Risk of Cardiotoxicity. Conclusion Both a single LVEF measurement and the rate of LVEF decrease strongly predict cardiotoxicity in early BC patients undergoing HER2-targeted therapy. Routine LVEF monitoring identifies individuals at high risk of cardiotoxicity that may benefit from more sensitive screening techniques such as strain imaging.


1991 ◽  
Vol 9 (12) ◽  
pp. 2148-2152 ◽  
Author(s):  
D J Perez ◽  
V J Harvey ◽  
B A Robinson ◽  
C H Atkinson ◽  
P J Dady ◽  
...  

One hundred forty-one patients with advanced breast cancer who had not received prior chemotherapy were randomly assigned to receive doxorubicin 60 mg/m2 or epirubicin 90 mg/m2 every 3 weeks. These doses were selected to produce equivalent toxicities. All patients were assessed for toxicity, and 138 patients were assessable for response. After a median of five treatment cycles, 47% (32 of 68) of doxorubicin-treated patients achieved a partial or complete response. Response duration and survival were 10 and 12 months for doxorubicin and 8 and 10 months for epirubicin, respectively. Noncardiac toxicities were similar for both drugs. Of 41 patients receiving doxorubicin who had serial left ventricular ejection fraction assessments, seven sustained a fall of 10% or more, and one patient developed congestive cardiac failure at a cumulative doxorubicin dose of 489 mg/m2. Of 39 patients receiving epirubicin who had serial cardiac assessments, five sustained left ventricular ejection fraction falls of 10% or more and two patients developed congestive cardiac failure at cumulative doses of 178 mg/m2 and 833 mg/m2. These data indicate that an epirubicin dose of 90 mg/m2 produces toxicity equivalent to doxorubicin 60 mg/m2 but does not improve response rates, response duration, or survival in advanced breast cancer.


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