The use of Myocardial Strain and Newer Echocardiography Imaging Techniques in Cancer Patients

Abstract

10.2217/FON.15.122 © 2015 Future Medicine Ltd The impressive strides in cancer research, screening, diagnosis and therapy over the past 30 years have led to markedly improved patient outcomes. Median survival for many patients with cancer are now measured in decades [1]. As a consequence, it is now expected that survivorship health issues be considered early within treatment plans. Cardiovascular disease is an important adverse effect of cancer treatment that can occur either during treatment or subsequent to it. This is a concern particularly among those treated with anthracyclines, tyrosine kinase inhibitors, and those receiving chest radiation [2–4]. The spectrum of cardiac disease from cancer therapy is wide. However, left ventricular (LV) dysfunction and heart failure are particularly important due to their associated poor prognosis [5,6]. Although several therapeutic options for treatment of chemotherapy-related cardiac dysfunction (CTRCD) exist, they appear to be most effective when initiated early before i rreversible cardiac damage has occurred [5]. LV ejection fraction The early identification of CTRCD has relied on the use of periodic surveillance of LV ejection fraction (LVEF) through various imaging modalities, including nuclear imaging and magnetic resonance imaging. More recently, echocardiography has emerged as the ideal modality for monitoring LVEF in patients treated for cancer due to its availability, portability and noninvasiveness, while sparing patients from radiation exposure. The cutoffs used to define CTRCD are varied in the literature thereby hampering attempts to study this entity systematically [7–9]. The recently published American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) consensus document defines CTRCD as a decrease in LVEF of >10 percentage points, to a value <53% with or without symptoms [7]. Regardless of the cut-off used, the ability to accurately and reproducibly measure LVEF is crucial. The Bi-plane Simpson’s method (Figure 1) with 2D echocardiography COMMENTARY Special Focus Issue: Cardio-oncology