Use of 2D Strain Imaging for Detecting Left Ventricular Dysfunction in Patients Receiving Pre and Post Chemotherapy with Anthracyclines

Abstract

Introduction: Cancer is a major public health and economical concern. Chemotherapy induced LV Dysfunction hinders the applicability of these agents. Anthracycline chemotherapy plays a major role in many cancer treatments, especially breast cancer. Cardiotoxicity is a major concern in this group as it can have early onset or late onset, clinically apparent or subclinical. Echocardiography is the non-invasive technique of choice in the imaging of patients before, during and after undergoing chemotherapy. Speckle tracking echocardiography gives an objective and qualitative assessment of LV function. This study was done to assess the risk factors associated with chemotherapy induced LV Dysfunction along with the feasibility of 2D speckle tracking strain imaging. Methods: 54 consecutive patients above the age of 18 years diagnosed to have breast cancer from November 2015 to October 2016 were included in this study. The patients were further divided into LV Dysfunction group and Non LV Dysfunction group at the end of the follow up. The baseline clinical, echocardiographic parameters and follow up parameters were compared in the 2 groups. Results: Anthracycline induced LV Dysfunction was found in 14.8% of the study population. Advanced age, low BMI, Diabetes, advanced cancer stage, number of chemotherapy cycles were all found to be associated with increased risk of developing chemotherapy induced LV dysfunction. 2D strain imaging was helpful in early detection of LV Dysfunction in 25% of the LV Dysfunction group. Among the patients who had LV Dysfunction at the end of the chemotherapy regimen, 75% had persistent LV Dysfunction during follow-up where as 25% recovered their LV Function. Conclusion: Chemotherapy induced LV Dysfunction remains a major public health concern and it is not uncommon. The development of LV Dysfunction in this group of patients should be carefully monitored by 2D strain imaging as it can help in detection of early onset of LV Dysfunction.