The contribution of the global longitudinal strain in the diagnosis of cardiovascular toxicity of cancer chemotherapy

Abstract

Cancer is a global health issue. Chemotherapy has improved the prognosis of these patients, but cardiovascular toxicity remains one of the most disabling complications. The assessment of the global longitudinal strain (GLS) of the left ventricle (LV) is a proven tool for early detection of this toxicity. Early diagnosis of cardiovascular toxicity of cancer chemotherapy using GLS to develop an early intervention strategy in these patients. We conducted a prospective, comparative and descriptive study from January to August 2019 on 100 patients between 16 and 60 years old, starting chemotherapy with cardiovascular toxicity. These patients, whose WHO performance index was between 0 and 1, had no history of heart disease, high blood pressure, diabetes, kidney or liver failure, and had not received other cardiotoxic treatments. A transthoracic echocardiography (TTE) was performed one week before and two weeks after chemotherapy by the same cardiologist. The definitions of heart failure and cardiovascular toxicity of cancer chemotherapy were those of the ESC. The average age was 46 ± 8 years old, with female predominance (SR: 0.25). Breast cancer was the predominant type of cancer (75%). Anthracyclines were the most used treatment (72%). There was a significant difference, before and after chemotherapy, in the values of LV ejection fraction (LVEF) measured by the Teichhloz method (67.75 ± 5.5% vs. 64.7 ± 5.6%, P = 0.002), LVEF measured by the 2D Simpson method (64.5 ± 3.83% vs. 61.85 ± 1.9%, P = 0.000) and LV GLS (−21.85 ± 1.9% vs. −20.08 ± 1.63%, P = 0.000). In addition, 1% of the patients, had a deterioration of the LV GLS > 15%, with a reduction of the LVEF less than 10%. Our study showed, in agreement with the current data, that the GLS does help in the early diagnosis of cardiovascular toxicity of cancer chemotherapy, thus allowing early institution of cardioprotective treatment.