Echocardiographic strategy for early detection of cardiotoxicity of doxorubicin: A prospective observational study

Background Cancer chemotherapy using anthracyclines is associated with cardiotoxicity (CTX), and left ventricular ejection fraction (LVEF) analysis is not sensitive to early cardiotoxic changes. Global longitudinal strain (GLS) monitoring helps screen subclinical CTX; however, the intervals at which it should be performed remain unclear. We aimed to evaluate the incidence of CTX in women with breast cancer and the associated factors and compare two echocardiographic monitoring strategies using two cutoff points for GLS variation. Methods Patients with breast cancer prescribed doxorubicin underwent serial LVEF and GLS assessments using two-dimensional echocardiography every 3 weeks for 6 months. Results We included 43 women; none developed a clinical CTX. Considering a percentage reduction in absolute GLS value of > 15%, subclinical CTX was present in 12 (27.9%) and six (14%) patients at 3-week and 3-month intervals, respectively ( P = 0.28). Additionally, considering a reduction of > 12%, subclinical CTX was present in 17 (39.5%) and 10 (23.3%) patients ( P = 0.16), respectively. There were no significant differences in either reference value at 3-week ( P = 0.19) and 3-month intervals ( P = 0.41). Age ≥ 60 years ( P = 0.018) and hypertension (HTN) ( P = 0.022) were associated with subclinical CTX in the univariate analysis. Conclusions There was no difference in the incidence of subclinical CTX between the two cutoff points and no benefit in performing echocardiography every 3 weeks compared with quarterly monitoring. Advanced age and HTN were associated with the development of subclinical CTX.