Value of Left Ventricular Global Longitudinal Strain Assessed by Two-Dimensional Strain Imaging in Early Detection of Anthracycline Mediated Cardiotoxicity

Abstract

: The goal of this study is to investigate whether alterations of myocardial global longitudinal strain and high ‐ sensitive cardiac troponin could be detected early in patients receiving anthracycline chemotherapy & if it could predict future cardiac dysfunction. Methods: Thirty patients with cancer treated with Adriamycin were studied. Blood collection for measurement of high sensitive troponin and echocardiography were performed at baseline, three months & six months of chemotherapy. Global longitudinal strain (GLS), were calculated using speckle tracking echocardiography. Left ventricular ejection fraction was measured by M-mode echocardiography. Results: LVEF although reduced after treatment, remained within the normal range (65±3.6% at base line vs. 63±2.7% at three months vs. 62±2.6% at six months of treatment, p = 0.002).LVIDd & LVIDs was highest after 6 months of chemotherapy. GLS was significantly reduced after treatment (-20.56±1.9% vs. -18.2±2.2% at three months vs -17.1±2.1 at six months of treatment, p<0.001). Subclinical LV dysfunction (>15% reduction in GLS compared to before therapy) occurred in 43%. Serum hs ‐ cTnI levels increased significantly after 3 months of treatment with anthracycline (0.0088± 0.012, vs. 0.345 ± 0.5 after three months of treatment, p = 0.001).There was positive correlation between EF & GLS while a negative correlation was found between hscTnI & GLS. Hs ‐ cTnI assay may allow an early identification of cardiac damage and therefore provide a way to minimize cardiac related mortality and morbidity while undergoing chemotherapy and afterwards.