Left atrial longitudinal strain as a predictor of Cancer therapeutics-related cardiac dysfunction in patients with breast Cancer

Abstract

Background: We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy. Methods: A total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared. Results: CTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%). Conclusions: PALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD.

Evaluation of left atrial function and mechanical dispersion in breast cancer patients after chemotherapy

“… 6 In contrast, Hyukjin Park et al suggested that a significant decline in LA strain developed after chemotherapy for breast cancer. 7 The respective changes in LASr, LAScd, and LASct in these patients is still a matter of debate. LA mechanical dispersion is a parameter related to arrhythmia, especially atrial fibrillation (AF).…”

“…Ana Teresa Timóteo et al suggested that no significant change in LA strain in breast cancer patients was observed after chemotherapy 6 . In contrast, Hyukjin Park et al suggested that a significant decline in LA strain developed after chemotherapy for breast cancer 7 . The respective changes in LASr, LAScd, and LASct in these patients is still a matter of debate.…”

Atrial Cardiomyopathy and Atrial Fibrillation in Cancer

“…Furthermore, a retrospective study including 92 therapy-naive cancer patients and their matched controls suggests that LA reservoir and functions are deteriorated in the cancer group [ 35 ]. Peak atrial longitudinal strain decline is a useful indicator of cancer therapeutics-related dysfunction in patients of breast cancer [ 36 ].…”

The Utility of Advanced Cardiovascular Imaging in Cancer Patients—When, Why, How, and the Latest Developments

“…Aspects of the left atrium that have been investigated include baseline left atrial volume index and left atrial longitudinal strain (33,34). Bergamini et al found that a dilated left atrium with normal LV function on baseline echocardiography prior to adjuvant or neoadjuvant traztuzumab is associated with the development of CTRCD in patient receiving trastuzumab (33).…”

“…Bergamini et al found that a dilated left atrium with normal LV function on baseline echocardiography prior to adjuvant or neoadjuvant traztuzumab is associated with the development of CTRCD in patient receiving trastuzumab (33). Park et al found peak atrial longitudinal strain decline at the end of chemotherapy could predict CTRCD with better sensitivity and specificity than LV GLS (34).…”