To access this material please log in or register

Register Authorize

Significance of global longitudinal systolic deformation by two-dimensional image for early diagnostics of chemotherapy-induced cardiotoxicity (preliminary data)

Nevsetov V.V., Shkolnik E.L., Vasyuk Yu.A.

Keywords: diagnostics, breast cancer, chemotherapy, CHF, echocardiography

DOI: 10.18087 / rhfj.2013.3.1787

Background. In recent years, a significant decrease in mortality from oncologic diseases has been observed. This progress is due to  both early diagnosis and more aggressive treatment of the detected disease. Despite high efficacy, some chemotherapies are associated with a risk of myocardial injury, even development of cardiomyopathy and CHF. Correction of the myocardial injury is most effective before appearance of clinically evident cardiomyopathy and considerable impairment of LV contractility. Aim. To evaluate the significance of global longitudinal systolic deformation using the two-dimensional image for early diagnosis of chemotherapy cardiotoxicity. Materials and methods. The study included 17 female patients with breast cancer without cardiovascular disease, who had undergone surgery treatment and were scheduled for chemotherapy with antracycline group drugs. EchoCG examination including analyses of LV EF (modified Simpson method) and global longitudinal systolic deformation by two-dimensional image (specialized workstation Echopac, General Electric) were performed for all patients during inclusion in the study and at 3 months of chemotherapy initiation. Results. For the whole group, LV EF remained unchanged during the treatment (61.3±4.0 % and 62.1±3.1 %; p=0.544). At the same time, a clinically significant decrease in LV EF by >5 % observed in 2 patients (11 %). In one of these patients, this decrease exceeded 10 %. In none of the patients, LV EF decreased below 50 %. Analysis of global longitudinal systolic deformation also did not reveal any significant changes (–19.7±2.1 % and –19.3±2.1 %; p=0.44). At the same time, 11 (65 %) patients showed reduced global longitudinal deformation. In 5 (29 %) patients, the port-treatment actual value of LV global deformation decreased below the normal range (18.4 %) and in 3 (18 %) patients, the decrease was more than 10 %. Conclusion. Global longitudinal systolic LV myocardial deformation is a sensitive marker of myocardial injury during chemotherapy and can be used for early detection of myocardial injury.
  1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61 (4):212–236.
  2. O’Shaughnessy J, Twelves C, Aapro M. Treatment for anthracycline-pretreated metastatic breast cancer. Oncologist. 2002;7 (Suppl 6):4–12.
  3. Swain S, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97 (11):2869–2879.
  4. Mercuro G, Cadeddu C, Piras A et al. Early epirubicin-induced myocardial dysfunction revealed by serial tissue doppler echocardiography: correlation with inflammatory and oxidative stress markers. Oncologist. 2007;12 (9):1124–1133.
  5. Jones LW, Haykowsky MJ, Swartz JJ et al. Early breast cancer: therapy and cardiovascular injury. J Am Coll Cardiol. 2007;50 (15):1435–1441.
  6. Jones RL, Ewer MS. Cardiac and cardiovascular toxicity of nonanthracycline anticancer drugs. Expert Rev Anticancer Ther. 2006;6 (9):1249–1269.
  7. Floyd JD, Nguyen DT, Lobins RL et al. Cardiotoxicity of cancer therapy. J Clin Oncol. 2005;23 (30):7685–7696.
  8. Chu TF, Rupnick MA, Kerkela R et al. Cardiotoxicity asso­ciated with tyrosine kinase inhibitor sunitinib. Lancet. 2007;370 (9604):2011–2019.
  9. Delemasure S, Vergely C, Zeller M et al. Preventing the cardiotoxic effects of anthracyclines: from basic concepts to clinical data. Ann Cardiol Angeiol (Paris). 2006;55 (2):104–112.
  10. Singal P. K., Iliscovic N., Timao U. et al. Adriamycin cardiomyopathy: pathophysiology and prevention. FASEB J. 1997;11 (12):931–936.
  11. van Dalen EC, Michiels EM, Caron HN, Kremer LC. Different anthracycline derivates for reducing cardiotoxicity in cancer patients. Cochrane Database Syst Rev 2006; 4: CD005006
  12. Cowie MR, Struthers AD, Wood DA et al. Value of natriuretic peptides in assessment with patients with possible new heart failure in primary care. Lancet. 1997;350 (9088):1349–1353.
  13. Clerico A, Recchia FA, Passino C, Emdin M. Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications. Am J Physiol Heart Circ Physiol. 2006;290 (1):H17–29.
  14. Nistico C, Bria E, Cuppone F et al. Troponin-T and myoglobin plus echocardiographic evaluation for monitoring early cardiotoxicity of weekly epirubicin-paclitaxel in metastatic breast cancer patients. Anticancer Drugs. 2007;18 (2):227–232.
  15. Kilickap S, Barista I, Akgul E et al. cTnT can be a useful marker for early detection of anthracycline toxicity. Ann Oncol. 2005;16 (5):798–804.
  16. Jurcut R, Wildiers H, Ganame J et al. Detection and monitoring of cardiotoxicity – what does modern cardiology offer? Support Care Cancer. 2008;16 (5):437–445.
  17. Ng R, Better N, Green MD. Anticancer agents and cardiotoxicity. Semin Oncol. 2006;33 (1):2–14.
  18. Harris L, Batist G, Belt R et al. Liposome-encapsulated doxorubicin compared with conventional doxorubicin in a randomized multicenter trial as first-line therapy of metastatic breast carcinoma. Cancer. 2002;94 (1):25–36.
  19. O’Brien ME, Wigler N, Inbar M et al. Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX / Doxil) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol. 2004;15 (3):440–449.
  20. Batist G, Ramakrishnan G, Rao CS et al. Reduced cardiotoxicity and preserved antitumor efficacy of liposome-encapsulated doxorubicin and cyclophosphamide compared with conventional doxorubicin and cyclophosphamide in a randomized, multicenter trial of metastatic breast cancer. J Clin Oncol. 2001 Mar 1;19 (5):1444–1454.
  21. Chan S, Davidson N, Juozaityte E et al. Phase III trial of liposomal doxorubicin and cyclophosphamide compared with epirubicin and cyclophosphamide as firstline therapy for metastatic breast cancer. Ann Oncol. 2004;15 (10):1527–1534.
  22. Cardinale D, Sandri MT, Martinoni A et al. Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy. Ann Oncol. 2002 May;13 (5):710–715.
  23. Zuppinger C, Timolati F, Suter TM. Pathophysiology and diagnosis of cancer drug induced cardiomyopathy. Cardiovasc Toxicol. 2007;7 (2):61–66.
  24. Tassan-Mangina S, Codorean D, Metivier M et al. Tissue Doppler imaging and conventional echocardiography after anthracycline treatment in adults: early and late alterations of left ventricular function during a prospective study. Eur J Echocardiogr. 2006;7 (2):141–146.
  25. Koyama J, Falk RH. Prognostic significance of strain doppler ima­ging in light-chain amyloidosis. JACC Cardiovasc Imaging. 2010;3 (4):333–342.
  26. Correia E, Rodrigues B, Santos LF et al. Longitudinal left ventricular strain in hypertrophic cardiomyopathy: Correlation with nonsustained ventricular tachycardia. Echocardiography. 2011;28 (7):709–714.
  27. Bansal M, Jeffriess L, Leano R et al. Assessment of myocardial viability at dobutamine echocardiography by deformation analysis using tissue velocity and speckle-tracking. JACC Cardiovasc Imaging. 2010;3 (2):121–131
  28. Fallah-Rad N, Walker JR, Wassef A et al. The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II-positive breast cancer treated with adjuvant traztuzumab therapy. J Am Coll Cardiol. 2011;57 (22):2263–2270.
  29. Jurcut R, Wildiers H, Ganame J et al. Strain rate imaging detects early cardiac effects of pegylated liposomal doxorubicin as adjuvant therapy in elderly patients with breast cancer. J Am Soc Echocardiogr. 2008;21 (12):1283–1289.
Nevsetov V.V., Shkolnik E.L., Vasyuk Yu.A. Significance of global longitudinal systolic deformation by two-dimensional image for early diagnostics of chemotherapy-induced cardiotoxicity (preliminary data). Russian Heart Failure Journal. 2013;14 (3):127-130

To access this material please log in or register

Register Authorize
Ru En