Value of Left Ventricular Global Longitudinal Strain Assessed by Two-Dimensional Strain Imaging in Early Detection of Anthracycline Mediated Cardiotoxicity

Document Type : Original Article

Authors

1 Cardiology department, Faculty of Medicine, Beni-Suef University, Egypt

2 Oncology department, Faculty of Medicine, Beni-Suef University, Egypt

Abstract

The goal of this study is to investigate whether alterations of myocardial global longitudinal strain and high‐sensitive cardiac troponin could be detected early in patients receiving anthracycline chemotherapy & if it could predict future cardiac dysfunction. Methods: Thirty patients with cancer treated with Adriamycin were studied. Blood collection for measurement of high sensitive troponin and echocardiography were performed at baseline, three months & six months of chemotherapy. Global longitudinal strain (GLS), were calculated using speckle tracking echocardiography. Left ventricular ejection fraction was measured by M-mode echocardiography.  Results: LVEF although reduced after treatment, remained within the normal range (65±3.6% at base line vs. 63±2.7% at three months vs. 62±2.6% at six months of treatment, p = 0.002).LVIDd & LVIDs was highest after 6 months of chemotherapy. GLS was significantly reduced after treatment (-20.56±1.9% vs. -18.2±2.2% at three months vs -17.1±2.1 at six months of treatment, p < 0.001). Subclinical LV dysfunction (>15% reduction in GLS compared to before therapy) occurred in 43%. Serum hs‐cTnI levels increased significantly after 3 months of treatment with anthracycline (0.0088± 0.012, vs. 0.345 ± 0.5 after three months of treatment, p = 0.001).There was positive correlation between EF & GLS while a negative correlation was found between hscTnI & GLS. Hs‐cTnI assays was significantly increased in patients with Drop in GLS as compared with patients with no Drop in GLS after 3 months follow-up. No statistically significant difference between drop in GLS or hs-cTnI levels and cumulative dose of anthracyclines. No clinical parameters were associated with the drop in GLS or elevation of hs‐cTnI levels. Conclusion: Measurement of LV GLS by 2D STE during & after anthracycline therapy combined with hs-cTnI assay may allow an early identification of cardiac damage and therefore provide a way to minimize cardiac related mortality and morbidity while undergoing chemotherapy and afterwards.

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References

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