Aug 2026· European Heart Journal, Supplement· Vol 28· 0 citations
TL;DR
The results showed that MWI behaves similarly to GLS, suggesting that combining the two methods—MWI and GLS—may enhance the detection of cardiotoxicity.
Abstract
Breast cancer is one of the most common malignancies worldwide. Despite advances in treatment, such as anthracycline-based chemotherapy and trastuzumab, which have contributed to increased survival of cancer patients, these therapies can increase the risk of cardiotoxicity, making cardiac monitoring crucial in this population. The Myocardial Work Index (MWI) has emerged as a tool to predict the risk of cardiotoxicity, especially in patients with significant blood pressure variations during treatment. Using the left ventricular pressure-strain loop technique, MWI evaluates myocardial work and calculates global work index (GWI), global wasted work (GWW), global constructive work (GCW), and global work efficiency (GWE).
To determine the added value of myocardial work indices compared with global longitudinal strain (GLS) assessed by transthoracic echocardiography (TTE) in the diagnosis of chemotherapy-associated cardiotoxicity in women with breast cancer.
This was a retrospective, observational, descriptive-correlational study. A total of 40 women with breast cancer were included through a non-probabilistic sampling method, all of whom underwent chemotherapy with anthracyclines and adjuvant therapy with trastuzumab. Serial echocardiographic monitoring of systolic and diastolic function parameters was performed, including the assessment of global longitudinal deformation and myocardial work index, at four time points: pre-treatment (baseline TTE), first evaluation during treatment (TTE 2), second evaluation during treatment (TTE 3), and post-treatment (final TTE). Cardiac dysfunction related to oncological therapy was defined as a decrease in LVEF to < 50% and/or a relative reduction in GLS of > 15%, according to the 2022 consensus document of the European Society of Cardiology (ESC). Study variables: systolic and diastolic blood pressure, left ventricular ejection fraction (LVEF), GLS, global work index, global wasted work, global constructive work, and global work efficiency - analysed using EchoPAC™ software (version 206).
The mean follow-up time between the first and last TTE was 17 months, with a standard deviation of 3.1 months. When analysed together and separately in two groups—women who developed cardiotoxicity and those who did not—the MWI indices showed patterns similar to GLS and LVEF, decreasing between TTE1 and TTE3 and partially recovering at final TTE, except for GWW, which behaved in the opposite manner. It was observed that in the group that developed cardiotoxicity, some women already had altered GWW and GWE before treatment. The most significant changes in all study variables occurred at TTE3.
This study highlighted the added value of MWI relative to GLS in diagnosing cardiotoxicity in women with breast cancer. The results showed that MWI behaves similarly to GLS, suggesting that combining the two methods—MWI and GLS—may enhance the detection of cardiotoxicity.Correlation between GLS and MWI
GLS and LVEF were the most sensitive echocardiographic parameters for differentiating between groups with and without cardiotoxicity, showing consistent changes throughout the study.
R. D. De Sousa, V. Fonseca, M. Henriques et al.· European Heart Journal, Supp...· 0 citations
Anthracyclines remain a cornerstone of breast cancer therapy but carry a significant risk of cancer therapy-related cardiac dysfunction (CTRCD). This study evaluates the incidence of CTRCD in an Indonesian setting using the latest 2022 ESC Cardio-Oncology guidelines, focusing on subclinical markers such as high-sensitivity Troponin I (hs-cTnI), Global Longitudinal Strain (GLS) and Mechanical Dispersion (MD).
This retrospective analytical cohort study involved 98 breast cancer patients treated with anthracyclines at a national referral hospital in Indonesia from July 2018 to February 2020. Clinical assessments, hs-cTnI, and echocardiography (LVEF, GLS, and MD) were performed at baseline, 1, 3, and 6 months. CTRCD was defined per the 2022 ESC criteria.
CTRCD occurred in 74.5% of patients, predominantly as asymptomatic mild cases (63.26%). While symptomatic CTRCD was relatively low (7.14%), asymptomatic dysfunction was detected as early as one-month post-chemotherapy. A significant progressive decline was observed in LVEF (68.2 ± 6.2% to 61.3 ± 8.8%,
p
< 0.001) and GLS (-19.7 ± 2.9% to -17.1 ± 3.5%,
p
< 0.001). Notably, mechanical dispersion significantly increased over time (
p
= 0.029), and median hs-cTnI surged from 1.6 ng/L to 82.2 ng/L (
p
< 0.001) by month 6.
The high incidence of asymptomatic CTRCD underscores the inadequacy of relying on clinical symptoms alone. Integration of hs-cTnI, GLS, and mechanical dispersion monitoring is may be essential for early detection and enables timely cardioprotective intervention.
A significant decline in right ventricular function is demonstrated during anthracycline-based cardiotoxic therapy and persisting up to one year after treatment completion, even in patients with low cardiotoxic risk, despite changes being subclinical and largely within normal ranges.
I. Gigovska Dimova, G. Petkovska, I. Ismaili et al.· European Heart Journal, Supp...· 0 citations
A simplified risk score based on readily available clinical and echocardiographic variables for predicting anthracycline-related cardiotoxicity and the RE-ACT score provides additional post-treatment prognostic value is developed and validated and supports a practical 2-step strategy for personalized surveillance in cardio-oncology.
D. Cardinale, Nicola Cosentino, Chiara Morocutti et al.· JACC CardioOncology· 1 citation
Anthracyclines (ANTs) are important chemotherapeutic drugs for the treatment of lymphoma. However, its cardiotoxicity poses a challenge to its continued use. The development of ARCD is influenced by multiple factors, making early detection challenging. Three-dimensional speckle tracking imaging (3D-STI) can quantitatively analyze myocardial strain by tracking the movement of myocardial spots. This study compared the parameters derived from conventional echocardiography, 3D-STI, and three-dimensional echocardiography at baseline (T0), 2 cycles of chemotherapy (T2) and 4 cycles of chemotherapy (T4), and analyzed the risk factors for ARCD. From January 2020 to December 2024, a total of 189 patients with non-Hodgkin lymphoma were recruited, all of whom received at least 4 cycles of ANT treatment. During chemotherapy and follow-up, 28 patients developed ARCD. Firth-penalized logistic regression demonstrated that age ≥65 years (aOR = 3.416, 95% CI: 1.241-9.913), hypertension (aOR = 3.051, 95% CI: 1.095-8.675), and cumulative ANT dose (aOR = 1.028, 95% CI: 1.017-1.040) were independently associated with an increased risk of ARCD. Conventional echocardiographic parameters, including LVEF, showed no significant changes. Compared with T0, right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were significantly increased at T4 (P<0.05), left ventricular global longitudinal strain (LVGLS) was significantly decreased at T2 (P<0.05), and left ventricular global circumferential strain (LVGCS) was significantly decreased at T4 (P<0.05). The absolute change in LVGLS from T0 to T2 (ΔLVGLS) was significantly and positively correlated with the cumulative ANT dose (R = 0.336, P<0.001). The cut-off value for predicting ARCD using ΔLVGLS was 3.5%. The area under the curve (AUC) was 0.852 and the respective sensitivity and specificity were 0.929 and 0.739. 3D-STI, particularly LVGLS, demonstrated significant value in the early identification of cardiac dysfunction in patients with lymphoma undergoing ANT treatment.
Jing Jiang, Xiaole Mu, Xiaomei Chen et al.· American Journal of Cancer R...· 0 citations
Objective Anthracycline-related cardiotoxicity may involve systemic inflammatory responses, and the neutrophil-to-lymphocyte ratio may change during chemotherapy as a marker for inflammatory and immune status. Considering this, we designed the present study to assess the predictive value of neutrophil-to-lymphocyte ratio combined with left atrial reservoir longitudinal strain for subclinical cancer therapy–related cardiac dysfunction during anthracycline chemotherapy in patients with breast cancer. Methods This prospective observational study enrolled 85 patients with breast cancer undergoing anthracycline chemotherapy. Neutrophil-to-lymphocyte ratio and left atrial reservoir longitudinal strain were measured before chemotherapy (T0), after the second cycle (T2), and after the fourth cycle (T4). Subclinical cancer therapy–related cardiac dysfunction was defined as a normal left ventricular ejection fraction with a ≥15% decrease in left ventricular global longitudinal strain compared with that at baseline. The predictive efficacy of the relative decrease in left atrial reservoir longitudinal strain, T2 neutrophil-to-lymphocyte ratio, and their combined model for subclinical cancer therapy–related cardiac dysfunction at T4 was evaluated using receiver operating characteristic curves. Results We found that 29.41% of the patients developed subclinical cancer therapy–related cardiac dysfunction. Multivariate analysis showed that both T2 neutrophil-to-lymphocyte ratio (odds ratio = 1.611, p = 0.002) and relative decrease in left atrial reservoir longitudinal strain (odds ratio = 1.426, p < 0.001) were independent predictors. Receiver operating characteristic analysis revealed an area under the curve of 0.896 for the combined model. Conclusions This study provides preliminary evidence for an association of T2 neutrophil-to-lymphocyte ratio and relative decrease in left atrial reservoir longitudinal strain with subclinical cancer therapy–related cardiac dysfunction during anthracycline chemotherapy in patients with breast cancer. In this cohort, their combined use suggested good predictive value.
Panpan Shao, Zhu-Chao Wu, Xuan Liu et al.· Journal of International Med...· 0 citations
