Baseline 3D-LVEF predicted cardiotoxicity (OR 0.91) at 12 months, while strain parameters worsened over time but did not predict cardiotoxicity at baseline.
Do speckle-tracking echocardiography parameters predict or monitor cardiotoxicity in breast cancer patients receiving anthracycline and/or trastuzumab?
Baseline 3D-LVEF predicts chemotherapy-induced cardiotoxicity, while speckle-tracking strain parameters are useful for detecting progressive subclinical myocardial impairment over 12 months.
Absolute Event Rate: 0% vs 0%
Abstract Background Cardiotoxicity remains a major concern in breast cancer patients receiving anthracycline and trastuzumab-based chemotherapy. While left ventricular ejection fraction (LVEF) is the conventional marker of cardiac function, it often fails to detect early myocardial impairment. Speckle-tracking echocardiography (STE) parameters have been proposed as early markers of subclinical dysfunction, but their role in predicting cardiotoxicity versus monitoring longitudinal changes remains unclear. Methods We conducted a prospective study including 185 breast cancer patients treated with anthracyclines and/or trastuzumab. Echocardiographic assessments were performed at baseline and at 3, 6, and 12 months post-chemotherapy. Left ventricular parameters included 3D-LVEF, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). Right ventricular free longitudinal wall strain (RV-FLWS) and left atrial strain (LAS) in reservoir (LASr), conduit (LAScd), and contraction (LASct) phases were also studied. Longitudinal changes were analyzed by comparing each follow-up (3, 6, and 12 months) to baseline using paired t-tests. Logistic regression identified baseline predictors of cardiotoxicity. Results Baseline 3D-LVEF was a significant predictor of cardiotoxicity at 12 months (OR = 0.91, 95% CI: 0.86–0.96, p=0.0015). However, LVEF remained stable over time (p=NS), failing to detect progressive myocardial dysfunction. In contrast, ventricular and atrial strain parameters exhibited significant deterioration at the 12-month follow up despite preserved LVEF: LV-GLS (-23.41% to -22.39%, p=0.004), LV-GCS (-30.06% to -28.49%, p0.001), RV-FLWS (-30.8% to -29.1%, p=0.002), LASr (-53.3% to -42.2%, p0.001), LAScd (-22.31% to -17.93%, p0.001), and LASct (-29.65% to -22.86%, p0.001). Despite these significant changes, neither atrial nor ventricular strain parameters predicted cardiotoxicity at baseline. Conclusion Baseline 3D-LVEF serves as an early predictor of cardiotoxicity, while strain parameters detect progressive myocardial impairment but do not predict cardiotoxicity at baseline. These findings highlight the complementary roles of LVEF and STE parameters in chemotherapy-induced cardiotoxicity assessment. Further studies should explore their combined utility for early detection and risk stratification.Table 1.Echocardiographic Follow-up Figure 1.Echocardiographic Follow-up
Martinez-Dominguez et al. (Sat,) reported a other. Baseline 3D-LVEF predicted cardiotoxicity (OR 0.91) at 12 months, while strain parameters worsened over time but did not predict cardiotoxicity at baseline.