Assessment of myocardial performance using three-dimensional echocardiography in cancer patients exposed to anthracycline-based chemotherapy and/or targeted therapy – a scoping review

BACKGROUND: Chemotherapy and targeted therapies, including anthracycline-based regimens or their combination, have significantly improved cancer patient survival; however, they are associated with cancer therapy-related cardiac dysfunction (CTRCD), which may not be adequately detected using conventional two-dimensional echocardiography. PURPOSE: To identify the available evidence on the application of three-dimensional echocardiography (3DE) in the evaluation of myocardial performance in patients undergoing anthracycline-based chemotherapy and/or targeted therapy using cancer patients as a cohort study. METHODS: This scoping review was performed based on the Joanna Briggs Institute (JBI) framework of conducting scoping reviews and was reported in following the Preferred Reporting Items of systematic reviews and meta-analyses extension to Scoping Reviews (PRISMA-ScR). It searched five electronic databases (MEDLINE through PubMed, Embase, Scopus, Web of Science and Cochrane Library) dating back to November 2025. Records were independently screened and data extracted by two reviewers, any disagreement in this process was resolved by discussing with one another and when required, consulting with a third reviewer. A synthesis of 5 eligible observational studies was done using a narrative approach. RESULTS: The studies that were included involved mostly breast cancer patients who were using anthracycline-based chemotherapy as a single agent or together with the use of HER2-targeted therapy. One of the studies assessed patients with chronic myeloid leukaemia receiving long term tyrosine kinase inhibitor (TKI) therapy whose treatment had not been exposed to anthracyclines. 3D measurements were taken to evaluate the baseline and follow-up assessment. Three-dimensional strain metrics, of which global longitudinal strain (GLS), global circumferential strain (GCS), and global area strain (GAS) were reported to identify features suggestive of subclinical myocardial dysfunction prior to observable reductions in left ventricular ejection fraction (LVEF). CONCLUSION: Available evidence indicates that 3DE, especially the three-dimensional myocardial strain analysis, may facilitate the earlier identification of subclinical myocardial dysfunction earlier in patients undergoing anthracycline-based chemotherapy and/or targeted therapy. Nevertheless, due to the limited number of included studies and heterogeneity in its methods, these results are to be viewed with reservations and larger standardized multicenter studies are justified.