Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Introduction: Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) is the gold standard in screening for chemotherapy-induced cardiotoxicity (CIC). Measurement of myocardial deformation using speckle tracking enables more detailed assessment of myocardial contractility. The aim of this study was to determine the relationship between global and regional longitudinal strain and CIC. Methods: This was a prospective study of 158 breast cancer patients undergoing chemotherapy with anthracyclines with or without adjuvant trastuzumab who underwent serial monitoring by transthoracic echocardiography with assessment of myocardial deformation. CIC was defined as a decrease in LVEF to <53%. Global longitudinal strain (GLS) was estimated using EchoPAC BT12 software on a GE Vivid E9 cardiac ultrasound system. Patients were classified according to the 2015 ASE/EACVI criteria as having impaired myocardial deformation when GLS was reduced (less negative), with a cutoff of -18%. Results: During a mean follow-up of 5.4 months (1-48 months), the incidence of CIC was 18.9%. A decrease in GLS was observed during follow-up for the entire cohort (baseline GLS -20.1±3.5% vs. -18.7±3.4% at last follow-up assessment, p=0.001). A total of 97 patients (61.4%) were observed to have impaired myocardial deformation (GLS ≥18%) at some point during follow-up. This decrease was more significant in patients who eventually developed CIC (GLS -17.2±2.5%, ଝ Please cite this article as: Portugal G, Moura Branco L, Galrinho A, et al. Importância da deformação longitudinal na deteção da cardiotoxicidade induzida por quimioterapia e na identificação de padrões específicos de afetação segmentar. Rev Port Cardiol. 2017;36:9---15. Resultados: Durante um período de seguimento médio de 5,4 meses (1-48 meses), a incidên-cia de CIT foi de 18,9%. Na população global observou-se uma deterioração significativa do GLS durante o tratamento com quimioterapia (-20,1 ± 3,5% versus 18,7 ± 3,4%, p = 0,001), com compromisso do GLS detetado durante em algum período do seguimento em 61,4% dos doentes. Esta deterioração foi mais marcada no subgrupo de doentes com CIT (GLS: -17,2 ± 2,5%, p = 0,02). Na análise regional da deformação longitudinal, verificou-se compromisso da contractilidade envolvendo preferencialmente os segmentos septais (seis em seis) e parede anterior (dois em três). Por regressão logística multivariada, o compromisso do GLS esteve independentemente associado ao desenvolvimento de CIT (odds ratio 4,88, IC 1,32-18,0, p = 0,017). Conclusões: O compromisso da deformação longitudinal é frequente em doentes submetidos a quimioterapia e mostrou um padrão de distribuição predominante a nível septal e anterior. A degradação da GLS foi um preditor independente de CIT. PALAVRAS-CHAVE

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“…11 GLS was defined as reduced (less negative) using the cutoff of -18% recommended by the ASE/EACVI for EchoPAC BT12 software. 12 …”

Section: Definitionsmentioning

confidence: 99%

Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity

Portugal

Branco

Galrinho

et al. 2017

Revista Portuguesa de Cardiologia (English Edition)

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“…Clinicians should be aware that a stable LVEF does not by itself rule out heart failure as the cause of dyspnea in a patient receiving trastuzumab chemotherapy for breast cancer. The monitoring of both diastolic and systolic function during the course of trastuzumab treatment with or without other chemotherapy agents is recommended by the recently published the ASE/EAC expert consensus statement (the American Society of Echocardiography/the European Association of Cardiovascular Imaging) [11] .…”

Section: Discussionmentioning

confidence: 99%

Trastuzumab induced diastolic heart failure

Zheng

Reyentovich

Nierodizik

et al. 2015

CRIM

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Background: Trastuzumab-induced cardiotoxicity has been well accepted. Cardiotoxicity especially with concomitant or sequential use of anthracycline has been clinically identified as decreased left ventricular ejection fraction with or without symptoms of heart failure. Acute diastolic heart failure has not been reported. Case report:A 62-year-old female patient with HER2 + positive breast cancer presented to the emergency room with acute heart failure symptoms after trastuzumab use. Chest X-ray and CT demonstrated acute pulmonary edema. Echocardiography showed normal left ventricular ejection fraction, elevated left ventricular filling pressure, and moderate pulmonary hypertension, which are consistent with acute diastolic heart failure. The patient symptoms resolved quickly with diuretic therapy and Trastuzumab was discontinued. A follow-up echocardiography showed normal left and right ventricular function and a follow-up right heart catheterization demonstrated normal cardiac filling pressure and normal cardiac index. Conclusions:Trastuzumab induced cardiac toxicity could occur in a spectrum-from transient diastolic heart failure to systolic heart failure. The monitoring of both diastolic and systolic function during the course of trastuzumab treatment with or without other chemotherapy agents should be considered.

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“…Kontrolne badania echokardiograficzne serca u chorych uwzględnionych w scenariuszach klinicznych 1-6 powinny być wykonywane przynajmniej co 2 cykle chemioterapii, natomiast po przekroczeniu dawki łącznej 200 mg/m 2 należy badania powtarzać przed każdym kolejnym cyklem [29,30]. 2.…”

Section: Scenariusz Klinicznyunclassified

“…4. Jeśli ośrodek dysponuje nowoczesnymi metodami obrazowania serca (śledzenie markerów akustycznych w echokardiografii -ocena globalnego odkształcenia podłużnego lewej komory [GLS]), to pojawienie się wykładników przemawiających za toksycznym uszkodzeniem serca powinno być wskazaniem do konsultacji kardioonkologicznej (wspólna konsultacja kardiologa i onkologa) z oceną uzasadnienia i możliwości kontynuowania chemioterapii z zastosowaniem doksorubicyny w formie liposomalnej [29]. Na podstawie GLS można prognozować wystąpienie objawowej niewydolności serca, jak również całkowite przeżycie u pacjentów leczonych antracyklinami [32].…”

Section: Scenariusz Klinicznyunclassified

Liposomal doxorubicin in patients with breast cancer and concomitant cardiovascular diseases — interdisciplinary expert opinion

Szmit¹,

Filipiak‬²,

Litwiniuk³

et al. 2016

Kardiol Pol

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Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Cited by 1,296 publications

References 236 publications

Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity

Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity

Trastuzumab induced diastolic heart failure

Liposomal doxorubicin in patients with breast cancer and concomitant cardiovascular diseases — interdisciplinary expert opinion

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