Role of Myocardial Strain Imaging in Cancer Therapy-Related Cardiac Dysfunction

Area of Science:

• Cardiology
• Oncology
• Medical Imaging

Background:

• Cardiotoxicity from cancer therapy poses a significant clinical challenge, balancing treatment efficacy with cardiac risk.
• Left ventricular ejection fraction (LVEF) has been the traditional metric, but its limitations in early detection are recognized.
• Cancer therapy-related cardiac dysfunction (CTRCD) necessitates improved monitoring strategies.

Purpose of the Study:

• To review the current role of myocardial strain imaging in managing patients undergoing cardiotoxic therapy.
• To highlight the utility of global longitudinal strain (GLS) in early cardiotoxicity detection.
• To discuss the challenges and future directions in standardizing GLS protocols for CTRCD.

Main Methods:

• Review of contemporary literature on myocardial strain imaging in cardiotoxic therapy.
• Focus on speckle-tracking echocardiography for global longitudinal strain (GLS) assessment.
• Analysis of GLS as a biomarker for early subclinical left ventricular dysfunction.

Main Results:

• Global longitudinal strain (GLS) is a sensitive indicator of early cardiotoxicity, preceding changes in LVEF.
• A relative reduction in GLS >15% is commonly used to identify patients at risk.
• Initiation of cardioprotective therapy based on GLS decline may preserve left ventricular function.
• The impact of GLS on long-term clinical outcomes remains to be fully established.

Conclusions:

• Myocardial strain imaging, particularly GLS, is a valuable tool for early detection of subclinical left ventricular dysfunction in patients on cardiotoxic chemotherapy.
• A significant decline in GLS warrants consideration for cardioprotective interventions and close monitoring.
• Further research, including randomized controlled trials with hard clinical endpoints, is needed to solidify the role of GLS in managing CTRCD and guiding chemotherapy decisions.