Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study.

Area of Science:

• Cardiology
• Oncology
• Medical Imaging

Background:

• Anthracycline chemotherapy is crucial for breast cancer treatment but can cause cardiotoxicity.
• Early detection of subclinical left ventricular (LV) dysfunction is vital for managing chemotherapy-induced cardiotoxicity.
• Two-dimensional (2D) strain analysis, particularly global longitudinal strain (GLS), shows promise in detecting early cardiac changes.

Purpose of the Study:

• To evaluate changes in LV systolic and diastolic function in breast cancer patients shortly after anthracycline chemotherapy.
• To identify potential predisposing factors for chemotherapy-induced cardiac dysfunction.
• To compare the sensitivity of GLS versus LV ejection fraction (LVEF) in detecting subclinical LV dysfunction.

Main Methods:

• 140 breast cancer patients underwent detailed echocardiography before and within seven days after anthracycline chemotherapy.
• Assessed parameters included LV ejection fraction (LVEF), global longitudinal strain (GLS), strain rate, radial and circumferential strain.
• Left atrial volumes and LV diastolic parameters were also evaluated to assess diastolic function.

Main Results:

• LV ejection fraction (LVEF) remained within normal limits post-treatment, but global longitudinal strain (GLS) significantly decreased (p<0.001).
• Subclinical LV dysfunction, defined as >11% reduction in GLS, was observed in 22% of patients.
• Impaired diastolic function increased from 46% to 57% (p<0.001), and was more prevalent in patients with reduced GLS.

Conclusions:

• Global longitudinal strain (GLS) is more sensitive than LVEF for detecting subclinical LV systolic dysfunction immediately after anthracycline therapy.
• A significant increase in diastolic dysfunction was noted post-chemotherapy, particularly in patients with reduced GLS.
• These findings underscore the interconnectedness of systolic and diastolic function and the utility of GLS in early cardiotoxicity detection.