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Background: Cancer therapy– related cardiac dysfunction (CTRCD) is nowadays a frequently encountered clinical presentation, and transthoracic echocardiography (TTE) is usually the routine imaging modality of its screening and detection. The aim is to early detect subclinical CTRCD using non invasive imaging techniques & cardiac biomarkers. Methods: Eighty-eight patients with cancer, planned to receive Anthracyclines(AC) or Trastuzumab (TZB) were enrolled, baseline screening included 2D TTE, GLS and cardiac troponin I and NtProBNP measurments before receiving any treatment, follow up at three and six months were done using the same variables to early detect CTRCD and start CPT even in cases of mild dysfunction. Results: Twenty six patients developed CTRCD, 18 had mild and 8 had moderate asymptomatic CTRCD defined by relative decline in GLS & LVEF following the latest ESC cardio-oncology guidelines. The percentage of change in GLS from baseline and at 3 and 6 months was able to detect CTRCD in both groups in our population which was >16.6% at 3 months with P value of 10.10% at 6 months with P value of of <0.001*and CI 0.765 – 0.935 .At three months GLS values ≤-18.6 was able to detect CTRCD with P value of of <0.001*and CI 0.673 0.885.Compared to patients who did not develop CRTD, patients with mild asymptomatic CTRCD had double levels of NT-Pro BNP with a median of (99.5 ) ( IQR: 44.0 – 154.0) at 3 months follow up with P value 0.037 which was normalized at 6 months. Conclusion: The relative decline of GLS and elevation of NT-proBNP were able to diagnose patients with subclinical CTRCD in patients receiving AC with early start of Cardioprotective Treatments (CPT) which enabled the patients to continue their chemotherapeutic treatment uninterrupted without developing serious grades of LV dysfunction and even some patients showed improvement after CPT.
Shabaan et al. (Sat,) studied this question.