Three-Dimensional Speckle-Tracking Echocardiography for the Global and Regional Assessments of Left Ventricle Myocardial Deformation in Breast Cancer Patients Treated with Anthracyclines

Background: Assessment of 2D/3D left ventricular ejection fraction (LVEF) and 2D global longitudinal strain (GLS) is the gold standard for diagnosing cancer therapeutics-related cardiac dysfunction (CTRCD). Although 3D speckle-tracking echocardiography (STE) has several advantages, it is not used in this setting. Methods: 105 breast cancer patients who underwent serial echocardiographic assessment during anthracycline therapy were included. STE was used to estimate 2D GLS, 3D GLS, 3D global circumferential strain (GCS), 3D global radial strain (GRS), and 3D global area strain (GAS). CTRCD was defined as an absolute decrease in 2D/3D LVEF > 10% to a value 15%. Results: 24 patients developed CTRCD. There was a significant worsening of all 3D strain parameters during chemotherapy. 3D strain regional analysis showed impaired contractility in the anterior, inferior, and septal walls. Variations of 3D GRS and 3D GCS were associated with a higher incidence of CTRCD and the variation of 3D GRS was an independent predictor of CTRCD. Variations of 3D GCS and 3D GRS had a good discrimination for predicting CTRCD, with optimal cutoff values of - 34.2% for 3D GCS and - 34.4% for 3D GRS. These variations were observed 45 and 23 days before the diagnosis of CTRCD, respectively. Conclusion: Variations of 3D strain parameters were predictive of and preceded CTRCD, and thus have added value over currently recommended 2D/3D LVEF and 2D GLS. Routine application of this technique should be considered to offer targeted monitoring and timely initiation of cardioprotective treatment.info:eu-repo/semantics/publishedVersio

Valutazione della cardiotossicità in pazienti oncologici mediante tecniche ecocardiografiche

L'elaborato si inserisce in un progetto sviluppato presso l'Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) di Meldola che riguarda la valutazione di parametri cardiologici che possano risultare indici predittivi di uno scompenso cardiaco in pazienti affetti da linfoma. Tutti i soggetti considerati nel progetto sono stati sottoposti a trattamenti chemioterapici facenti uso di antracicline e la cui funzionalità cardiaca è stata controllata periodicamente tramite ecografia bidimensionale e volumetrica, utilizzando il sistema VividE9 della GE Healthcare. L'obiettivo dell'analisi è quello di ricercare se oltre alla frazione di eiezione esistono parametri più predittivi di una eventuale cardiotossicità come gli strain, calcolati attraverso l'ausilio della tecnica ecografica

Early detection of cardiotoxicity in chemotherapy-treated patients from real-time 3D echocardiography

Cardiotoxicity is a well-known adverse effect of various chemotherapeutic agents that can be monitored by echocardiography. A decrease of left ventricular ejection fraction (LVEF) during the therapy might indicate dangerous effects of the drug on the myocardium and triggers consideration of therapy modification or interruption. We hypothesized myocardial deformation could identify preclinical myocardial dysfunction earlier than conventional LVEF allowing the administration of treatments to avoid cardiac side-effects. Sixty-five patients who were newly diagnosed with breast cancer, were enrolled to be evaluated by echocardiography before cancer therapy, during the therapy at 16 weeks (16w) and at follow up after 32 weeks (32w). Following the recommendation, 24 patients (36.9%) showed cardiotoxicity; 11 (16.9%) interrupted the therapy due to a severe cardiac dysfunction and at 32w only 4 patients recovered. In this group at 16w, strain analysis showed a significant reduction for all strain values that were all predictive of cardiotoxicity independently from LVEF and radial strain resulted an independent prognostic index of cardiotoxicity. The assessment of myocardial deformation indexes might provide additional echocardiographic tools to assess cardio-toxic effects beyond LVEF. © 2013 CCAL