Role of Two Dimensional Left and Right Ventricular Speckle Tracking Echocardiography in Early Detection of Chemotherapy Induced Ventricular Systolic Dysfunction

Abstract

Abstract Background Cancer and cardiovascular diseases are the main causes of mortality worldwide. Although the incidence of cancer is rising, modern comprehensive management including surgery, chemotherapy and radiotherapy led to decreased mortality and prolonged survival, but also a large spectrum of cardiovascular complications. Since mortality from patients who develop heart failure secondary to chemotherapy is as high as 60% by 2 years. Early detection of subclinical Cancer Therapeutic Related Cardiac Dysfunction (CTRCD) is of utmost importance, conventional EF measurement fails to detect subtle changes in LV function, so a more sensitive tool is needed. Objective To detect early subclinical left & right ventricular dysfunction based on measurement of 2D LV & RV speckle tracking derived strain values. Patients and Methods The current study is a prospective study which included 101 asymptomatic female patients with newly diagnosed breast cancer who received anthracycline ± trastuzumab based chemotherapy regimen. A comprehensive echocardiographic examination was performed to all patients prior to receiving the chemotherapy (T0), at 3 months (T1) and at 6 months after (T2). All patients had pre- treatment normal LV EF. We aimed at studying the changes in LV & RV mechanics and detecting whether they can help in early prediction of cardiotoxicity. Cardiotoxicity was defined decrease in EF > 10% from baseline value to EF < 55% in asymptomatic patients or > 5% in symptomatic patients “as defined by the cardiac review and evaluation committee (CREC)”. Results The mean age of the study population was 48.75±10.07 years. CTRCD occurred in 24 patients (25.5%) with mean EF by Simpson`s method 59.29±3.50 % at (T0), 49.54±5.63% at (T1), 45.79±4.49% at (T2). While in non-CTRCD patients the mean EF was 60.21±2.80% at (T0), 59.13±2.53% at (T1), 58.29±2.63% at (T2). RV systolic function impairment (S`<10 cm/s) was more prevalent occurring in 37 patients representing 39.4% of the study population. By univariate and multivariate regression analysis LV GLS at (T1) (cut-off value <-15% with relative 12.5% reduction from the baseline value) was a strong predictor of CTRCD, but combining LV GLS with RV GLS & RV FWLS was the strongest (AUC=0.947, sensitivity=91.67%, specificity=90%). Conclusion Anthracycline ± Trastuzumab treatment leads to changes in LV & RV mechanics with more prevalent deterioration in RV values. Presence of lower LV & RV strain values at the base line together with reduction of these values after chemotherapy treatment both can predict later development of CTRCD. Combining LV GLS with RV GLS & FWLS values at (T1) is the strongest predictor of subsequent CTRCD.