Baseline impaired global longitudinal strain (< -18%) predicted NYHA class II heart failure in 100% of patients undergoing trastuzumab therapy, compared to 0% of those with normal baseline strain.
Cohort (n=47)
Does baseline global longitudinal strain (GLS) predict the development of myocardial dysfunction and clinical heart failure in breast cancer patients undergoing trastuzumab therapy?
Baseline impaired global longitudinal strain (< -18%) strongly predicts the subsequent development of LVEF reduction and clinical heart failure in breast cancer patients receiving trastuzumab.
Absolute Event Rate: 100% vs 0%
Abstract Background Cardiotoxicity remains a significant concern in breast cancer patients receiving trastuzumab. Left ventricular global longitudinal strain (GLS) is a sensitive tool for detecting subclinical myocardial dysfunction before changes in ejection fraction (EF) become evident. Objective To assess the predictive value of GLS in identifying patients at risk for myocardial dysfunction during and after chemotherapy with trastuzumab. Methods We prospectively studied 47 women aged 52 to 63 years with HER2-positive breast cancer scheduled for adjuvant trastuzumab therapy. All patients underwent transthoracic echocardiography including speckle-tracking strain analysis before initiation and after completion of chemotherapy. Baseline LVEF was between 50% and 60% in all patients, with no symptoms of heart failure. Valvular assessment revealed moderate mitral regurgitation in 10 patients, moderate tricuspid regurgitation in 7, and combined moderate mitral and tricuspid regurgitation in 5 patients. The remaining 25 had no hemodynamically significant valvular lesions. Results At baseline, impaired GLS ( –18%) was identified in 15 patients. Following chemotherapy, the number of patients with abnormal strain increased to 28. All patients with initially abnormal GLS experienced further EF reduction and developed symptoms consistent with NYHA class II heart failure. None of the patients with normal baseline GLS developed clinical heart failure. Conclusions GLS is a valuable early marker for predicting myocardial dysfunction in patients undergoing trastuzumab therapy. Routine strain imaging prior to and during chemotherapy may improve risk stratification and guide timely cardioprotective interventions in cardio-oncology practice.
Dimitrova et al. (Thu,) conducted a cohort in HER2-positive breast cancer (n=47). Impaired baseline global longitudinal strain (GLS < -18%) vs. Normal baseline GLS was evaluated on Development of clinical heart failure (NYHA class II). Baseline impaired global longitudinal strain (< -18%) predicted NYHA class II heart failure in 100% of patients undergoing trastuzumab therapy, compared to 0% of those with normal baseline strain.