The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Abstract

Purpose The primary aim of this study was to evaluate early changes in cardiac function after anthracycline therapy with layer‐specific speckle‐tracking echocardiography (STE) and mechanical dys‐synchrony. Methods A total of 78 breast cancer patients (ranging 31~72 years) exposed to anthracycline treatment were recruited in this study. All patients received both conventional two‐dimensional speckle‐tracking echocardiographs at baseline, as well as after the completion of 2 and 4 cycles of the regimen. Layer‐specific longitudinal strain (LS) and circumferential strain (CS) of the 3 myocardial layers (endocardium, mid‐myocardium, and epicardium) were automatically measured. Peak systolic dispersion (PSD) was defined as the standard deviation of the time to peak strain of the 18 segments, divided by the RR interval. Results There were no significant differences in conventional echocardiographic parameters during treatment (all P > .05). Peak endocardium CS at basal level decreased significantly after 2 and 4 cycles compared with baseline (both P = .001), while PSD significantly increased in that same period versus baseline (both P = .000). Endocardium and mid‐myocardium LS, peak mid‐myocardium and epicardium CS at the basal level, peak CS of all three layers at the papillary level, and peak endocardium and mid‐myocardium CS at the apical level all significantly decreased after 4 cycles, compared with baseline and 2 cycles (all P = .000). Conclusion This study showed that myocardial deformation impairment occurred as early as 2 cycles after anthracycline chemotherapy. Endocardium CS at the basal level and left ventricular dys‐synchrony index PSD were the initial cardiac abnormalities in anthracycline‐treated breast cancer patients.

Speckle tracking echocardiography in the early detection and prediction of anthracycline cardiotoxicity in diffuse large B‐cell lymphoma treated with (R)‐CHOP regimen

“…We found evidence of diastolic dysfunction during follow‐up, with prolonged IVRT and lower E velocity. However, these diastolic parameters did not demonstrate value in predicting subsequent cardiotoxicity, which was consistent with previous studies . Because the abnormalities of these parameters may be the result of changes in load conditions caused by side effects of chemotherapy (vomiting, diarrhea, and nausea) rather than the real changes in diastolic performance, the use of diastolic parameters remains questionable in this context.…”

“…However, these diastolic parameters did not demonstrate value in predicting subsequent cardiotoxicity, which was consistent with previous studies. 22 Because the abnormalities of these parameters may be the result of changes in load conditions caused by side effects of chemotherapy (vomiting, diarrhea, and nausea) rather than the real changes in diastolic performance, the use of diastolic parameters remains questionable in this context. These simple indicators, therefore, might be useful in the absence of myocardial strain analysis available.…”

Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study

“…To measure the DI in assessing LVD, different imaging techniques such as tissue Doppler (calculating the Yuindex), 2DSTE (as done in our study), 3D echocardiography or MRI can be used [20]. Dyssynchrony as a marker of early-onset anthracycline-induced cardiotoxicity has been demonstrated by Li et al with an increased peak systolic dispersion measured by SD of T2P systolic LS of 18 segments (4CH, 3CH and 2CH) [22]. Dyssynchrony as a marker of late-onset anthracycline-induced cardiotoxicity has been shown by Okama et al investigating 32 CCS and 12 controls.…”

Protective effect of a chronic hypobaric hypoxic environment at high altitude on cardiotoxicity induced by doxorubicin in rats: a 7 T magnetic resonance study

“…Significant reductions in LV longitudinal strain in subendocardial segments were observed after 3 cycles of chemotherapy, while conventional LV systolic and diastolic conventional parameters, as well as LVEF, were relatively spare (36). Other studies have reported that LV regional wall motion abnormalities are closely associated with the development of cancer therapy-related cardiac dysfunction in patients undergoing chemotherapy and may also be an important predictor of DIC (37)(38)(39)(40)(41). To the best of our knowledge, we are the first to use strain analysis to evaluate the cardioprotective effect of a natural highaltitude environment on DIC.…”