Abstract 14460: The Strain by Two-Dimensional Speckle Tracking is Reduced After Two Years of Anthracycline Chemotherapy in Patients With Normal Left Ventricular Ejection Fraction
Background: Five to 35% of patients (pts) using doxorubicin develop left ventricular (LV) dysfunction or heart failure. The early identification of cardiac involvement facilitates handling these pts. The strain assessed by Speckle Tracking (2D-STE) has proved useful for the identification of sub-clinical heart disease.
Aims: The aims of this study were: a) to investigate the role of strain measured by 2D-STE in the identification of sub-clinical LV dysfunction in pts who used doxorubicin (DOX); b) to investigate the determinants of strain behavior in cancer survivors.
Methods: Cross-sectional study. Examined 40 pts that used DOX (mean dose, 242mg/m2) in the last two years (median time) and 41 controls (CTL) matched for age, gender, and BMI. The LV systolic function was assessed by LVEF (Simpson), as well as by LV global longitudinal (ELL), circumferential (ECC) and radial (ERR) strain. Multivariate linear regression analysis (stepwise-MLR) was used. Independent variables: variables with p< 0.20 in univariate analysis and those with biological plausibility to interfere in strain. Dependent variables: ECC (model 1) and ELL (model 2). All participants had LVEF > 55% and were free of heart failure (Framingham).
Results: The percentage of hypertension, diabetes mellitus, smoking, women, black, overweight/obese, hypercholesterolemia and alcohol use was similar in both groups, as well as age, LVEF, LV mass index, waist circumference, and BMI (p> 0.05 for all). SBP and DBP were higher in CTL group (p< 0.05). LV global ELL was decreased in the DOX group (-12.4 ± 2.6%) compared with CTL (-13.4 ± 1.7%), p=0.044. The same for ECC: -12.1 ± 2.7% (DOX) vs -16.7 ± 3.6% (CTL), p< 0.001. LV global ERR was similar between groups (p=0.885). In the MLR analysis, DOX was the unique independent predictor for ECC reduction (B=4.429, p< 0.001). DOX (B=1.289, p=0.012) and age (B =-0.057, p=0.029) were independent markers for ELL reduction.
Conclusions: a) LV global ELL and ECC, assessed by 2D-STE, are reduced in patients who received DOX therapy in the last two years, despite normal LVEF, suggesting presence of subclinical LV dysfunction; b) DOX therapy was an independent predictor for ECC reduction in cancer survivors; c) The prior use of DOX and age were independent markers for ELL reduction.
- © 2013 by American Heart Association, Inc.