Independent and Incremental Value of Deformation Indices for Prediction of Trastuzumab-Induced Cardiotoxicity

Cardiotoxicity From Human Epidermal Growth Factor Receptor‐2 (HER2) Targeted Therapies

“…Assessment of LVEF alone by either method appears insensitive to detect subclinical changes and predict subsequent cardiotoxicity. Decreases in myocardial deformation (strain) precede changes in LVEF and have been consistently predictive of cardiac dysfunction from trastuzumab 82, 83. The American Society of Echocardiography recommends global longitudinal strain measured by speckle tracking echocardiography as the modality of choice for detection of subclinical myocardial changes and risk prediction 17.…”

“…The American Society of Echocardiography recommends global longitudinal strain measured by speckle tracking echocardiography as the modality of choice for detection of subclinical myocardial changes and risk prediction 17. A decrease of <8% from baseline is likely insignificant, whereas a relative drop of more than 15% is likely pathological 82. Importantly, there have been no studies assessing whether interventions based on changes in strain alter outcomes.…”

Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity

“…In a multicenter study comparing echocardiographic parameters in patients with HF, global longitudinal strain (GLS) assessment, a parameter evaluating longitudinal aspect of myocardial contraction using deformation imaging, appeared to have a higher and more reliable prognostic value than LVEF for the prediction of cardiac events and cardiac deaths [20]. 2D speckle tracking strain has already been evaluated in studies for a total of more than 700 patients concomitantly to the administration of cardiotoxic anticancer agents, with encouraging results concerning its capability to diagnose subclinical LV dysfunction of subsequent clinical relevance [21][22][23][24][25][26][27]. Based on these data, serial strain measurements are suggested during anticancer treatment [11••].…”

“…Trastuzumab was initiated with close monitoring of LVEF (every 3 weeks) using multimodality approach (2DE, 3DE, and GLS) and with cardioprotective treatment titrated to the maximal tolerated dosage. CMR cardiac magnetic resonance, CO cardiac output, CTRCD cancer therapeutic-related cardiac dysfunction, GLS global longitudinal strain, LVEDV left ventricular end diastolic volume, LVEF left ventricular ejection fraction, LVESV left ventricular end systolic volume, SV stroke volume anticancer agents [21][22][23][24][25][26][27]. Cutoffs value for relative percentage reduction during surveillance which are suggestive of clinically significant cardiotoxicity has been proposed in the ASE/EACVI expert consensus document [11••], although further studies are needed to validate these findings.…”

Is cardiac wasting accompanied by skeletal muscle loss in breast cancer patients receiving anticancer treatment?

“…In predicting and diagnosing of cardiac dysfunction, biomarkers such as B‐type natriuretic peptide and cardiac troponin have shown promising results as well as echocardiography. Namely, elevated B‐type natriuretic peptide and increased cardiac troponin were associated with subsequent left ventricular dysfunction and cardiovascular events, respectively,3, 4 and abnormal strain imaging in echocardiography is currently the strongest predictor of cardiotoxicity 5. On the other hand, no biomarker has been developed for the prediction and diagnosis of muscle wasting, despite extensive research 6, 7, 8.…”