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Three-dimensional speckle-tracking echocardiography for the global and regional assessments of left ventricle myocardial deformation in breast cancer patients treated with anthracyclines

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Abstract

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 < 54% or a relative decrease in 2D GLS > 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.

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  1. Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal

    Madalena Coutinho Cruz, Luísa Moura Branco, Guilherme Portugal, Ana Galrinho, Ana Teresa Timóteo, Pedro Rio, Rita Ilhão Moreira, Tiago Mendonça, Ana Leal, Fernanda Gameiro & Rui Cruz Ferreira

  2. Oncology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, EPE, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal

    Sónia Duarte Oliveira & Ricardo Luz

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Coutinho Cruz, M., Moura Branco, L., Portugal, G. et al. Three-dimensional speckle-tracking echocardiography for the global and regional assessments of left ventricle myocardial deformation in breast cancer patients treated with anthracyclines. Clin Res Cardiol 109, 673–684 (2020). https://doi.org/10.1007/s00392-019-01556-1

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