Echocardiography and cancer therapeutics-related cardiac dysfunction

Cancer therapeutics-related cardiac dysfunction (CTRCD) has become a leading cause of morbidity and mortality for cancer survivors, with the mortality rate for patients with CTRCD reportedly being as high as 60% by 2 years after treatment. Although early detection of subclinical left ventricular (LV) dysfunction is essential for delaying progression to heart failure (HF) in patients with a history of using cardiotoxins, assessment of such dysfunction can be challenging. CTRCD may present initially as asymptomatic LV dysfunction and ultimately as symptomatic HF, which can occur even decades after discontinuation of the treatment. Once CTRCD has developed, the mortality rate is very high, because CTRCD is believed to be refractory to conventional pharmacological therapy and to be associated with a poor prognosis. Thus, there has been a growing interest in early detection of CTRCD by means of global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography, because it is a more sensitive and robust parameter for detecting subclinical LV dysfunction than other conventional LV functional parameters such as LV ejection fraction. This article reviews the utility of GLS for early detection of cardiotoxicity in patients during and after cancer chemotherapy, and future perspectives for the management of such patients.