Cardioprotective effect of upfront use of ACEI in breast cancer patients undergoing treatment using global longitudinal strain to evaluate left ventricular dysfunction

Introduction: frequency of breast cancer is rising, it become evident that chemotherapy regimens exhibit cardiotoxic effects. The myocardial injury caused by chemotherapy agents varies in severity, frequently quantified as decreases in (LVEF). Global longitudinal strain (GLS) showed early chemotherapy correlated with myocardial injury. Aim of the study: Assessment of the efficacy of Speckle Tracking echocardiography for the early identification of left ventricular failure in breast cancer cases receiving chemotherapy. & Assess efficacy of ACEI upfront cardioprotective effect on patients under chemotherapy or chemotherapy and radiotherapy.Subjects and Methods: The study included 200 breast cancer female patients receiving chemotherapy and /or radiotherapy.The patients were randomized to 2 groups, one of them received upfront therapy of ACE inhibitors in association with chemotherapy dose while the other did not.Speckle tracking echocardiography was performed as part of the echocardiographic examination for both groups, performed at 0,3, 6 ,9 ,12 months follow up after the first cycle of treatment in same week. ACE (Ramipril 1.25 mg ) administered to trace the effectiveness of ACE in myocardial protection of patients under chemotherapy . Results: We found that GLS is able to detect subclinical left ventricle dysfunction earlier than left ventricular ejection fraction measurement in women undergoing chemotherapy.The chemotherapy induced LV dysfunction is potentially reversible with the use of ACEI that resulted in improved clinical outcomes.Conclusions: GLS has shown potential in detecting early cardiac injury associated to chemotherapy. ACEI demonstrated cardioprotective effect in patient undergoing chemotherapy for breast cancer.Keywords: (Breast Cancer, GLS, speckle tracking echocardiography)