Global longitudinal strain: a useful everyday measurement?

Abstract

Herceptin (Trastuzumab) is a widely used and effective drug for the treatment of Her2+ breast cancer but its cardiotoxic side effects require regular monitoring by echocardiography. A 10% reduction in left ventricular ejection fraction can lead to suspension of treatment and therefore has significant implications for patient prognosis in terms of cardiac and cancer outcomes. Assessment of LV function by conventional 2D biplane method of discs (2DEF) has limitations in accuracy and reproducibility. Global longitudinal strain (GLS) is becoming more widely available and user friendly. It has been shown to demonstrate myocardial damage earlier in treatment than 2DEF, allowing the option of pharmacological intervention at a pre-clinical stage and preventing the interruption of Herceptin. This study compares the reproducibility of GLS with that of 2DEF in a routine clinical environment. Fifty echocardiograms performed on female patients undergoing Herceptin treatment were used to measure both 2DEF and GLS within the recommended standard appointment time of 40 min. The data were re-measured (blind) by the same operator a minimum of 14 days later to determine intra-operator variation. These data were also measured by a second operator (blind), to assess inter-operator variation. Analysis by direct comparison, intra-class correlation (ICC), coefficient of variation (CV) and Bland–Altman plots demonstrated that GLS is a more reproducible measurement than 2DEF. This is important to prevent clinical decisions being erroneously based on variation in operator measurement. The investigation also shows that with advances in machine software this is a practical addition to routine assessment rather than merely a research tool.

Cardiac Function After Radiation Therapy for Breast Cancer

“…Given the median follow-up time in the current study of 7 years, the interval may be too short for the development of a decreased LVEF of <54%. Because of the limitations in sensitivity and reproducibility of the LVEF, we decided to also use the GLS of the LV which is a more sensitive method to detect subclinical systolic dysfunction of the LV 25 .…”

Diagnosis, Treatment, and Prevention of Cardiovascular Toxicity Related to Anti-Cancer Treatment in Clinical Practice: An Opinion Paper from the Working Group on Cardio-Oncology of the Korean Society of Echocardiography

“…In case of GLS, breast cancer studies, including those on trastuzumab, showed that a relative reduction of 2–15% from baseline GLS was associated with increased rate of cardiotoxicity, and accordingly, reductions > 15% from baseline in GLS have been suggested for detection of LV dysfunction by most experts' consensus statements. 15) 86) 114) 115) 116) 117) …”

Added value of speckle tracking in the evaluation of cardiac function in patients with sickle cell disease

“…It has been proposed that the left ventricle global longitudinal strain (LV‐GLS) could be a useful tool for the detection of early systolic dysfunction in patients under cardiotoxic chemotherapy (Thavendiranathan et al , ). Moreover, the high reproducibility of the LV‐GLS represents an advantage over the left ventricle ejection fraction (LVEF) (King et al , ; Medvedofsky et al , ). Compared to the LVEF, the LV‐GLS is less affected by changes in loading conditions, which makes it a potentially useful tool in patients with sickle cell disease (SCD), due to the chronic overload associated with SCD.…”