To study the usefulness and comparison of myocardial strain imaging by 2D and 3D echocardiography for early detection of cardiotoxicity in patients undergoing cardiotoxic chemotherapy

Abstract

Background Chemotherapy-induced cardiotoxicity constitutes subclinical myocardial dysfunction, arrhythmias, pericarditis, coronary vasospasm, and significant symptomatic heart failure. Anthracyclines pose higher risk for long-term cardiac dysfunction, with increased incidences of morbidity and mortality. Hence, early detection of chemotherapy-induced cardiac dysfunction may prompt an earlier treatment modification. Aim To evaluate global, longitudinal, radial, and circumferential strain changes in adult patients undergoing anthracycline chemotherapy along with the usefulness of three-dimensional (3D) echocardiography as the new modality over two-dimensional (2D) echocardiography. Methods This was a single centre, prospective, observational study that included asymptomatic patients free from any cardiac signs and symptoms attributable to heart failure, who underwent potentially cardiotoxic chemotherapy for malignancy from December 2017 to November 2018 at a tertiary care centre in India. Baseline demographics were recorded, and 2D and 3D echocardiography was performed at baseline and after completion of four cycles of chemotherapy. Results All the 55 patients received a cumulative dose of doxorubicin of less than 550 mg/m 2 . Follow-up period from the beginning of doxorubicin therapy was 108 ± 14 days. 9 patients were excluded from the study due to poor 3D images, so data analysis was done only for 46 patients. In 2D echocardiography, only global longitudinal strain (GLS) was observed to be significantly reduced (Δ18.33%; P < 0.001). 2D ejection fraction (EF) did not show significant change (Δ0.67%; P = 0.176), while by 3D echo, EF reduced significantly (Δ3.55%; P < 0.001). 3D global longitudinal (Δ29.19%; P < 0.001), circumferential (Δ30.65%; P < 0.001), area (Δ21.61%; P < 0.001), and radial (Δ29.66%; P < 0.001) strains were observed to be significantly reduced at follow-up. Conclusion Myocardial dysfunction induced by cardiotoxic chemotherapy can be detected earlier by using 2D GLS, 3D volumetric analysis, and 3D strain analysis by calculating global, longitudinal, radial, and circumferential strain changes. 3D echocardiographic assessment seems to be more accurate in picking out small changes in left ventricular functions, but at the cost of slightly poor image quality as compared to the 2D echocardiography. These newer techniques could potentially improve the ability for early detection of subclinical abnormalities of LV function in patients undergoing cardiotoxic chemotherapy and thus early initiation of treatment could be possible.

3D-based strain analysis and cardiotoxicity detection in cancer patients received chemotherapy

“…The reduction of 3D global longitudinal strain by 29.19%, circumferential strain by 30.65%, area strain by 21.61%, and radial strain by 29.66% after completion of chemotherapy. EF was significantly reduced by 3D echocardiography, but no patient had a fall of EF to less than 50% by either 2D or 3D [ 42 ].…”

Promising approaches to noninvasive diagnosis of subclinical cardiovascular toxicity of chemotherapy

“…Использование объемной модели позволяет повысить воспроизводимость результатов, провести оценку таких параметров деформации ЛЖ, как глобальная продольная, радиальная и циркулярная, и количественно определить глобальную площадь деформации [54]. Поскольку глобальная площадь деформации является результатом сочетания продольной и циркулярной деформации, данный показатель можно рассматривать как интегрирующий параметр деформации, что делает его привлекательным для изучения субклинической дисфункции ЛЖ, в том числе и на фоне ХТ [55][56][57].…”

A complex approach to continuous cardiac monitoring of neoadjuvant chemotherapy: Observational study

“…Ранний скрининг и превентивная профилактика данной категории пациентов могут улучшить результаты и замедлить прогрессирование КАХ при выборе стратегии ранней превентивной профилактики. У 22 (44%) пациентов с повышенным уровнем NT-ProBNP обнаружено абсолютное снижение GLS до значений менее 20%, и 12 (24%) пациентов имели относительное снижение GLS>15% [30,31].…”