Global longitudinal strain for detection of subclinical anthracycline
cardiotoxicity in breast cancer patients by three dimensional speckle
tracking echocardiography
Abstract
Ninety-four women with breast cancer who received epirubicin (360 mg/m2)
underwent three-dimensional (3D) speckle tracking echocardiography (STE)
at baseline, after the completion of two cycles and four cycles of the
regimen respectively were enrolled in the study. 3D STE assessment
included left ventricular ejection fraction (LVEF), global area strain
(GAS), global longitudinal strain (GLS), global circumferential strain
(GCS) and global radial strain (GRS). Meanwhile, serum high-sensitive
troponin I (hs‐cTnI) and N-terminal portion pro-natriuretic peptide type
B (NT-proBNP) were measured. Cancer therapy-related cardiac dysfunction
(CTRCD) was defined as reduction of 3D LVEF > 10% to a
value < 54%. CTRCD occurred in 9 (9.6%) patients during
anthracycline treatment. The changes in 3D LVEF was not significant
after chemotherapy. Values of 3D GLS and 3D GAS showed a significant
deterioration during anthracycline treatment (p < 0.001 and p
= 0.001, respectively) in all patients. Compared to non-CTRCD patients,
the CTRCD patients had significantly reduction in 3D GLS (-15.5±3.2% vs
-17.0±2.7%, p<0.001) and 3D GAS (-31.0±3.9% vs -32.3±3.3%,
p<0.001) at the end of anthracycline chemotherapy. The optimal
cutoff value with -15.5% of 3D GLS had a good discrimination for
predicting CTRCD, with 87.5% sensitivity and 74.6% specificity.
Spearman correlation analysis showed a moderate negative correlation
between 3D GLS and anthracycline doses (r = - 0.54, p <
0.001). 3D GLS could potentially improve the ability for detecting
early, subclinical anthracycline-related cardiotoxicity in breast cancer
patients.