Abstract 12440: Global Longitudinal Strain With 2D-Speckle Tracking Predicts Chemotherapy-related Systolic Dysfunction Independenty of Basal Assessment in Patients With Breast Carcinoma
Introduction: Recent developments in anticancer therapies for breast carcinoma allowed an improvement in patient survival, notwithstanding a parallel increase of cardiovascular morbidity. Systolic dysfunction and heart failure represent a relevant problem in these patients due to insidious onset and the potential irreversible nature of cardiac damage. Therefore, strong and early predictors of chemoteraphy-realted systolic dysfunction are been sought.
Hypothesis: To investigate global longitudinal strain (GLS) assessed by 2D-speckle tracking as a potential early marker of systolic dysfunction in chemoteraphy-treated breast cancer patients.
Methods: Population include sixty-nine patients, referred to our unit for cardiologic assessment prior to neo-adjuvant or adjuvant chemotherapy for breast cancer. Patients with prior heart failure and atrial fibrillation were excluded. The protocol included a baseline echocolorDoppler and 2D-strain evaluation before the beginning of chemotherapy and subsequent serial controls every 3 months. In patients developing systolic dysfunction, further unscheduled assessment were made at the cardiologist discretion.
Results: Nineteen (27.5%) patients were classified as having cardiotoxicity according to CREC and ESMO criteria. ROC curve analysis showed that a 3-month GLS <-16% predicted subsequent development of systolic dysfunction with good sensitivity and specificity (80% and 90% respectively), with a negative predictive value of 92%. Cardiotoxicity occurred in 8 patients at 6 months and in 11 patients within 9 months; among all of those, 84% of patients already showed a GLS <-16% at 3-month, and 100% at 6-month, confirming the early diagnostic potential of GLS. After chemotherapy suspension and introduction of cardioprotective drugs, GLS remained depressed longer than left ventricular ejection fraction (LVEF) over 1-year follow-up.
Conclusions: Strain imaging with 2D-speckle tracking allows the identification of patients at high risk of developing systolic dysfunction. An absolute cut-off value of -16% can provide a useful, time-independent clinical tool to improve follow-up management and concentrate resources on high-risk patients.
Author Disclosures: F. Guerra: Consultant/Advisory Board; Modest; Boheringer-Ingelheim. M. Marchesini: None. D. Contadini: None. A. Menditto: None. M. Morelli: None. E. Piccolo: None. M. Tagliavento: None. N. Battelli: None. R. Berardi: None. S. Cascinu: None. A. Capucci: Consultant/Advisory Board; Modest; Sorin, Boston Scientific, Medtronic, St. Jude Medical, Boheringer-Ingelheim.
- © 2015 by American Heart Association, Inc.