Role of Myocardial Strain Imaging by Echocardiography for the Early Detection of Anthracyclines-Induced Cardiotoxicity

Figures

• 

  Fig. 1. Female patient aged 36 years, not known to be diabetic, not hypertensive, non-smoker, overweight with BMI=25 kg/m2, not known to be cardiac, no thyroid or chest diseases, diagnosed as breast cancer. She was planned to receive doxorubicin. On the first visit (V1): (a, b): baseline echocardiography showed no significant abnormal echo-doppler data, EF=71% and GLS=−22.5%. On the second visit (V2): she received 215 mg/m2 of doxorubicin, only complaining of loss of appetite, echocardiographic examination (c, d) showed: EF=70% and GLS=−21% with AbGLS=1.5 and ΔGLS=6.7%. On the third visit (V3): the cumulative dose reached was 427 mg/m2, echocardiographic examination (e, f) showed: EF=67% and GLS=−18.8%, AbGLS=3.7, ΔGLS=16.4% (Significant reduction in GLS or subclinical cardiotoxicity). (a, c, e): 2D echocardiographic examination for assessment of LVEF by M-mode. (B, D, F): Strain echocardiography examination to measure GLS showing Bull’s eye.

• 

  Fig. 2. Male patient aged 58 years, known to be hypertensive and smoker, not known to be diabetic or cardiac before, he denied having any thyroid or chest problems, He had average BMI=23kg/m2 diagnosed as lymphoma. He was planned to receive doxorubicin. On the first visit (V1): (a, b): baseline echocardiography showed no significant abnormal echo-doppler data, EF=62%, and GLS=−18.2%. On the second visit (V2): He received a cumulative dose of 276 mg/m2, no complaint, Echocardiographic examination (c, d) showed: EF=58%, GLS=−12%, AbGLS= 6.2 and ΔGLS=34% (Subclinical cardiotoxicity). On the third visit (V3): Cumulative dose of doxorubicin= 457mg/m2, complaining of dyspnea grade III, echocardiographic examination (e, f) showed:, Ef=53%, GLS=−11.6%, AbGLS=6.6 and ΔGLS=36.2% (Cardiotoxicity occurred). (a, c, e): 2D echocardiographic examination for assessment of LVEF by M-mode. (B, D, F): Strain echocardiography examination to measure GLS showing Bull’s eye.

• 

  Fig. 3. ROC curve for Δ GLS to diagnose abnormal EF (n= 4).