Anthracycline-induced left atrioventricular dyssynchrony in children with leukemia: a cardiac magnetic resonance imaging study of functional and strain analysis

Right ventricular strain dynamics during anthracycline therapy in breast cancer patients stratified by cardiotoxicity risk: preliminary results

It is suggested that RV strain assessment provides information complementary to conventional LV–based cardiotoxicity criteria and may occur in the absence of concurrent changes in conventional LV cardiotoxicity parameters as currently defined.

Beyond the left ventricle: right ventricular function as an early marker of cancer therapy related cardiac dysfunction

Cancer therapy–related cardiac dysfunction (CTRCD) remains a major limitation of anthracycline and anti-HER2 therapy, and most monitoring focuses on left ventricular (LV) function. Data on the role of right ventricular (RV) function as an early marker of CTRCD are limited. To evaluate the association between echocardiographic RV parameters - TAPSE, tricuspid S’ velocity and RV free-wall longitudinal strain (RV-FWLS) - and the development of CTRCD in patients treated with anthracyclines and/or anti-HER2 therapy. Retrospective, single-center observational study including patients treated with anthracyclines and/or anti-HER2 agents and followed in Cardio-oncology consultation in a district hospital. CTRCD was defined according to contemporary cardio-oncology criteria based on LV ejection fraction and global longitudinal strain. RV function was evaluated by TAPSE, tricuspid S’ and RV-FWLS. We included 65 women, mean age 60±10 years. Chemotherapy regimens comprised anthracyclines only in 45%, anti-HER2 therapy only in 10% and combined anthracyclines plus anti-HER2 in 45%. According to the HFA-ICOS tool, 34% were at low, 37% at moderate, 17% at high and 12% at very high cardiovascular risk at baseline. Over a median follow-up of 36 months (IQR 23–70), CTRCD occurred in 15 patients (23%). 9 patients (14%) died, including 2 cardiovascular deaths. At baseline, TAPSE and tricuspid S’ were similar in patients with and without CTRCD (TAPSE 22±2.7 vs 23±2.1mm, p=0.19; S’ 12.5±1.9 vs 12±1.8cm/s, p=0.30), whereas RV-FWLS was significantly less negative in those who subsequently developed CTRCD (−23.6±3.1% vs −26.1±2.8%, p=0.02). During follow-up, patients with CTRCD showed a greater decline in RV function, with larger reductions in TAPSE (−2±1.9 vs −0.5±1.5mm, p=0.01) and RV-FWLS (+4.8±3.7 vs +2.9±3%, p=0.04). A relative reduction in RV-FWLS ≥15% occurred in 60% of patients with CTRCD versus 20% of those without (p=0.01). In univariable logistic regression, baseline RV-FWLS was associated with higher odds of CTRCD (OR per 1% less negative strain 1.17, 95% CI [1.03–1.28], p=0.01). In this cohort of women treated with anthracyclines and anti-HER2 therapy, RV-FWLS identified patients who developed CTRCD, supporting RV strain as a useful tool for early risk stratification and refinement of cardio-oncology surveillance strategies.

LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN FOR EARLY DETECTION OF ANTHRACYCLINE-INDUCED CARDIOTOXICITY IN ADULT BREAST CANCER PATIENTS: A SYSTEMATIC REVIEW

LV GLS appears to be a sensitive and clinically useful echocardiographic marker for the early detection of anthracycline-induced cardiotoxicity in adult breast cancer patients and may improve identification of subclinical cardiac dysfunction before a measurable decline in left ventricular ejection fraction occurs.

Age-Related Impairment of Left Atrial Phasic Strain in Childhood Cancer Survivors Treated with Anthracyclines.

Childhood cancer survivors (CCSs) are at increased risk of cancer therapy-related cardiac dysfunction following anthracycline chemotherapy. Although left atrial (LA) strain assessed by speckle-tracking echocardiography has emerged as a sensitive marker of diastolic dysfunction, it remains unclear when during survivorship LA dysfunction becomes detectable in CCSs treated with anthracyclines.In this retrospective observational case-control study, 92 CCSs (aged 4-32 years) and 96 age-matched healthy controls underwent echocardiography. Participants were stratified into three age groups (4-12, 13-18, and 19-32 years). LA reservoir, conduit, and pump strains were measured using two-dimensional speckle-tracking echocardiography from the apical four-chamber view. Conventional echocardiographic parameters, including mitral inflow velocities (E and A waves), E/A ratio, and tissue Doppler-derived e' and E/e', as well as left ventricular longitudinal strain (LVLS), were assessed.Conventional diastolic parameters did not significantly differ between CCSs and controls within corresponding age groups. However, in young adult CCSs (19-32 years), all three components of LA phasic strain (reservoir, conduit, and pump strains) were significantly reduced compared with age-matched controls. LVLS was also significantly lower in this group, whereas younger CCSs showed no significant differences in LA strain.LA phasic dysfunction was most evident in young adult CCSs despite preserved conventional diastolic indices, suggesting that age-stratified LA strain assessment may help identify survivorship stages at which atrial dysfunction becomes detectable.

Late cardiac effects of anthracycline-based therapy in childhood cancer survivors: a CMR study of cardiac strain and function.

Chemotherapy-associated cardiotoxicity in women with breast cancer: assessment of left atrial strain by transthoracic echocardiography

GLS and LVEF were the most sensitive echocardiographic parameters for differentiating between groups with and without cardiotoxicity, showing consistent changes throughout the study.