Abstract
BackgroundWe investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy.MethodsA total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared.ResultsCTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%).ConclusionsPALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD.
Highlights
With the improvements in early detection and therapeutic advances including chemotherapy, cancer survival rates have been gradually improved [1]
Left ventricular ejection fraction (LVEF) has been broadly used as a diagnostic criterion [2], and recent studies have suggested that Left ventricle (LV) global longitudinal strain (GLS) is a useful parameter in detecting subclinical myocardial damage and can be used as a predictor of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) [3]
Baseline characteristics CTRCD was not identified on follow up echocardiography which was performed after the completion of chemotherapy, but identified in 13 patients (18.1%) on echocardiography which was performed during (7 [9.7%] patients) or just after completing trastuzumab therapy (6 [8.3%] patients)
Summary
With the improvements in early detection and therapeutic advances including chemotherapy, cancer survival rates have been gradually improved [1]. Left atrial (LA) GLS using 2-dimensional (2D) speckle-tracking echocardiography has been suggested as a method to represent LA functional state. It is a new promising approach for LA mechanics and electromechanical coupling [6], and it showed good correlation with pulmonary capillary wedge pressure, even better than E/e’ ratio in advanced heart failure (HF) [7]. We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy
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