Key result
Peak atrial longitudinal strain (PALS) decline after chemotherapy was significantly greater in patients who later developed CTRCD compared to those who did not (15.0% vs 8.9%, p<0.001), predicting future CTRCD with 76.9% sensitivity and 81.4% specificity.
Why the study?
To evaluate the usefulness of left atrial strain measurement in predicting cancer therapeutics-related cardiac dysfunction after trastuzumab therapy in breast cancer patients who did not develop CTRCD after chemotherapy.
Does peak atrial longitudinal strain (PALS) decline predict cancer therapeutics-related cardiac dysfunction in breast cancer patients undergoing trastuzumab therapy?
Observational (n=72)
No
Does peak atrial longitudinal strain (PALS) decline predict cancer therapeutics-related cardiac dysfunction in breast cancer patients undergoing trastuzumab therapy?
Absolute Event Rate: 15% vs 8.9%
p-value: p=<0.001
Peak atrial longitudinal strain (PALS) decline after chemotherapy is a sensitive and specific predictor of future trastuzumab-induced cardiotoxicity in breast cancer patients, outperforming LVGLS decline.
PALS decline may flag higher CTRCD risk after trastuzumab; hypothesis-generating and should not yet change practice.
BACKGROUND: We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy. METHODS: A total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared. RESULTS: CTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%). CONCLUSIONS: PALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD.
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Park et al. (2020) conducted an observational in Breast cancer (n=72). Development of CTRCD vs. No CTRCD was evaluated on Peak atrial longitudinal strain (PALS) decline at chemotherapy completion (%) (p=<0.001). Peak atrial longitudinal strain (PALS) decline after chemotherapy was significantly greater in patients who later developed CTRCD compared to those who did not (15.0% vs 8.9%, p<0.001), predicting future CTRCD with 76.9% sensitivity and 81.4% specificity.
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