Integrative speckle-tracking echocardiography for the early detection and prediction of cancer therapy–related cardiac dysfunction

The cancer therapy–related cardiac dysfunction (CTRCD) induced by anthracycline could involve the whole heart. However, the overall changes of strain parameters, including the atrial and right heart strains, myocardial work, along with the established left ventricular global longitudinal strain (GLS), during cancer therapy, remain unclear. In this prospective cohort study, 83 women undergoing anthracycline treatment for breast cancer, underwent serial echocardiographic examinations at baseline (pre-chemotherapy, T0), after 1 to 4 cycles (T1-T4) and 3 months after treatment completion (T5). Speckle tracking echocardiography (STE) derived parameters, including GLS, left atrial strains, right heart strains and myocardial work indices, were measured. CTRCD was defined as a relative reduction of > 15% in GLS from baseline or severer cardiac impairments according to current joint guidelines. Generalized estimating equations quantified the association between changes in strain parameters and anthracycline-induced CTRCD. Univariate logistic regression and receiver operating characteristic curves were used to explore the combined values of identified strain parameters for the prediction of CTRCD. Twenty-five (30.1%) patients developed CTRCD during the serial examinations. Compared with baseline, significant declines in GLS, left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), global work index (GWI) and global constructive work (GCW) were observed at T1. For trajectories analysis, GLS, LASr, LAScd, left atrial total emptying fraction, GWI and GCW were different between patients with and without CTRCD (all P < 0.05). The relative changes of GLS, LASr, GWI at T1 were identified as predictors of CTRCD, with improved predictive value when combined together. Not only the GLS, but also the LASr and myocardial work indices were significantly impaired just after one cycle therapy of anthracycline. The integrative STE could serve as an early detective and predictive approach for CTRCD.