Applications of global left ventricular myocardial strain in detection of anthracycline-induced cardiotoxicity in breast cancer survivors with postoperative chemotherapy

Abstract

Objective To assess the clinical significance of three-dimensional speckle tracking imaging (3D-STI) in the evaluation of left ventricular myocardial function in breast cancer survivors with postoperative anthracycline-based chemotherapy.Methods A total of 51 breast cancer survivors with postoperative anthracycline-based chemotherapy were recruited and 31 female healthy volunteers as the controls.Conventional echocardiography and 3D-STI derived parameters [including global longitudinal strain (GLS) and global area strain (GAS)] were measured before and at 3 and 6 anthracycline-based chemotherapeutic cycles.The receiver operating characteristics (ROC) curve was constructed to determine optimal sensitivity and specificity of 3ID-STI derived parameters for the prediction of future cardiotoxicity.Results In comparison with the controls and baseline cases,GLS and GAS deteriorated significantly (P ＜ 0.05 for both).No statistical difference in GCS and conventional parameters showed before and after the initiation of chemotherapy (P ＜0.05,respectively).The ROC curves showed that GAS as the best 3D-STI predictor of patients who develop cardiotoxicity during the follow-up.The area under ROC(AUC) of GAS was 0.894,and its optimal cut-off value was-28.4％,with a specificity of 88.0％ and a sensitivity of 82.9％.AUC of GLS was 0.802,and its optimal cut-off value was-14.3％,with a specificity of 62.0％ and a sensitivity of 85.4％.Conclusions Early decreases in GAS and GLS based on 3D-STI may allow the prediction of subsequent cardiotoxic development accurately in breast cancer survivors with postoperative anthracycline-based chemotherapy. Key words: Echocardiography; Breast neoplasms; Ventricular function, left; Athracyclines; Cardiotoxins ; Speckle tracking imaging