Evaluation of left ventricular transmural mechanics after anthracycline chemotherapy in patients with breast cancer by speckle tracking imaging

Abstract

Objective To evaluate the left ventricular transmural mechanics changes of breast cancer patients between before and after anthracycline chemotherapy by two-dimensional speckle tracking imaging (2D-STI), and to predict early cardiotoxicity caused by anthracycline. Methods Forty-six breast cancer patients with postoperative anthracycline-based chemotherapy were recruited. Echocardiography were performed on all subjects before and at 1, 3 and 6 anthracycline-based chemotherapeutic cycle. Global longitudinal strain(GLS), endocardial longitudinal strain(LS-endo), epicardial longitudinal strain(LS-epi), global radial strain(GRS), endocardial radial strain(RS-endo), epicardial radial strain(RS-epi), global circumferential strain(GCS), endocardial circumferential strain(CS-endo) and epicardial circumferential strain(CS-epi) were assessed by 2D-STI and transmural myocardial strain gradient-longitudinal strain(TMSG-LS), transmural myocardial strain gradient-radial strain(TMSG-RS), transmural myocardial strain gradient-circumferential strain(TMSG-CS) were calculated. Conventional echocardiographic parameters and strain-related parameters before and after chemotherapy were compared. The receiver operating characteristics(ROC)curve was performed to determine sensitivity and specifity of strain parameters for prediction value of cardiotoxicity induced by anthracycline chemotherapy. Results ①After the sixth cycle of anthracycline chemotherapy, 9 patients (16.4%) had developed anthracycline-induced cardiotoxicity, and 37 patients (80.4%) did not meet the criteria for cardiotoxicity. ②There were no significant differences in conventional echocardiography parameters between before and after chemotherapy (P>0.05). Left ventricular ejection fraction (LVEF), fractional shortening (FS) and E/A significantly decreased, but E/e significantly increased after six cycles of chemotherapy (P LS-endo> GLS> LS-epi. Conclusions After three cycles of chemotherapy, the decreases of TMSG-LS, LS-endo, GLS and LS-epi preceded the change of LVEF and other strain parameters, TMSG-LS and LS-endo can accurately and early detect anthracycline chemotherapy-induced cardiotoxicity. Key words: Echocardiography; Breast neoplasms; Anthracyclines; Transmural myocardial strain gradient; Two-dimensional speckle tracking imaging