Role of Global Left Ventricle Longitudinal Strain and Cardiac Biomarkers in the Early Detection of Cancer Therapy-Related Dysfunction in Patients Treated With Cardiotoxic Chemotherapeutic Drugs in a Cardio-Oncology Clinic

Background Breast cancer (BC) affects many women, and with the prevalence of anthracyclines (AC) used in treatment, cardiotoxicity is a commonly encountered problem. Objective The aim is to early detect subclinical cancer therapy-related cardiac dysfunction (CTRCD) using noninvasive imaging techniques and cardiac biomarkers. Methods Eighty-eight patients with cancer who planned to receive AC or trastuzumab (TZB) were enrolled. Baseline screening included two-dimensional (2D) transthoracic echocardiogram (TTE), global longitudinal strain (GLS), cardiac troponin I (cTnI), and N-terminal pro-brain natriuretic peptide (NT-ProBNP) measurements. Follow-up was done at three and six months to early detect CTRCD. Results Twenty-six patients developed CTRCD, defined by a relative decline in GLS and left ventricular ejection fraction (LVEF). The percentage of change in GLS from baseline and at three and six months was able to detect CTRCD in both groups in our population, which was >16.6% at three months with a p-value of <0.001* and CI 0.783-0.934 and >10.10% at six months with a p-value of <0.001* and CI 0.765-0.935. At three months, GLS values of ≤-18.6 were able to detect CTRCD with a p-value of <0.001* and CI 0.673 0.885. Compared to patients who did not develop CRTD, patients with mild asymptomatic CTRCD had double levels of NT-ProBNP with a median of (99.5) (interquartile range (IQR): 44.0-154.0) at three months. Conclusion The relative decline of GLS and elevation of NT-proBNP were able to diagnose patients with subclinical CTRCD in patients receiving AC with early start of cardioprotective treatments.