Accuracy of echocardiography for detecting cancer therapeutics-related cardiac dysfunction

Abstract

The survival rate of breast cancer patients has been improved thanks to the progress accomplished in chemotherapy therapeutics and targeted therapies. However, cardiovascular side effects have increased. Cancer therapeutics-related cardiac dysfunction (CTRCD) is a serious side effect of anti-cancer treatment. The aim of our study was to determinate the role of echocardiography in the detection of CTRCD. This was a longitudinal, prospective and monocentric study. Eighty female patients diagnosed with breast cancer and addressed to the echocardiography lab of Ariana hospital, were enrolled between 2017 and 2019. An echocardiographic monitoring were realised according to the chemotherapy protocol. CTRCD is defined as a drop of left ventricular ejection fraction (LVEF) by > 10 percentage points from baseline to a value < 50%. A new entity named subclinical systolic dysfunction, is defined by drop of global longitudinal strain (GLS) by > 15% from baseline, however, LVEF remains > 50%. The average age of our patients was 49.9 ± 10.8 years. The mean LVEF was at 64 ± 4.4%. The incidence of CTRCD was 6% (5 patients). It was reversible in 3 cases after the initiation of a cardioprotective treatment. The incidence of subclinical cardiac dysfunction was 25%. Cardioprotective treatment was administered in this case and none of them evolved to CTRCD. At univariate analysis, baseline LVEF between 50 and 55% (P < 0.001), GLS decrease (P < 0.001) and adriamycin administration (P = 0.01) were predictive factors of cardiotoxicity. At multivariate analysis, only borderline baseline LVEF between 50% and 50% was a predictive factor of CTRCD (P = 0.002). Echocardiographic monitoring of breast cancer patients revealed a CTRCD in 5 cases (6%). GLS allowed the diagnosis of a subclinical cardiac dysfunction in 25% of cases. In breast cancer patients, both Simpson biplane LVEF and GLS should be assessed.