Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection

Negishi, Kazuaki, Negishi, Tomoko, Haluska,Brian A., Hare, James L., Plana, Juan Carlos and Marwick, Thomas H. (2014) Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. European Heart Journal Cardiovascular Imaging, 15 3: 324-331. doi:10.1093/ehjci/jet159


Author Negishi, Kazuaki
Negishi, Tomoko
Haluska,Brian A.
Hare, James L.
Plana, Juan Carlos
Marwick, Thomas H.
Title Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection
Journal name European Heart Journal Cardiovascular Imaging   Check publisher's open access policy
ISSN 2047-2404
2047-2412
Publication date 2014-03-01
Year available 2013
Sub-type Article (original research)
DOI 10.1093/ehjci/jet159
Open Access Status Not Open Access
Volume 15
Issue 3
Start page 324
End page 331
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Aims
The variability of ejection fraction (EF) poses a problem in the assessment of left ventricular (LV) function in patients receiving potentially cardiotoxic chemotherapy. We sought to use global longitudinal strain (GLS) to compare LV responses to various cardiotoxic chemotherapy regimens and to examine the response to cardioprotection with beta-blockers (BB) in patients showing subclinical myocardial damage.

Methods and Results
We studied 159 patients (49 ± 14 year, 127 women) receiving anthracycline (group A, n = 53, 46 ± 17 year), trastuzumab (group T, n = 61, 53 ± 12 year), or trastuzumab after anthracyclines (group AT, n = 45, 46 ± 9 year). LV indices [ejection fraction (EF), mitral annular systolic velocity, and GLS] were measured at baseline and follow-up (7 ± 7 months). Patients who decreased GLS by ≥11% were followed for another 6 months; initiation of BB was at the discretion of the clinician. Anthracycline dose was similar between group A and group AT (213 ± 118 vs. 216 ± 47 mg/m2, P = 0.85). Although ΔEF was similar among the groups, attenuation of GLS was the greatest in group AT (group A, 0.7 ± 2.8% shortening; T, 1.1 ± 2.7%; and AT, 2.0 ± 2.3%; P = 0.003, after adjustment). Of 52 patients who decreased GLS by ≥-11%, 24 were treated with BB and 28 were not. GLS improved in BB groups (from -17.6 ± 2.3 to -19.8 ± 2.6%, P < 0.001) but not in non-BB groups (from -18.0 ± 2.0 to -19.0 ± 3.0%, P = 0.08). Effects of BB were similar with all regimens.

Conclusions
GLS is an effective parameter for identifying systolic dysfunction (which appears worst with combined anthracycline and trastuzumab therapy) and responds to cardioprotection in patients administered beta-blockers.
Keyword Anthracyclines
Beta-blocker
Cardiotoxicity
Strain
Trastuzumab
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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