Abstract Background Cancer therapy-related cardiac dysfunction (CTRCD) presents a significant clinical challenge for HER2-positive breast cancer patients undergoing treatment with anthracyclines and trastuzumab. The importance of early detection in preventing irreversible cardiac damage cannot be overstated. Although left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are established indicators, emerging data suggest that left atrial strain markersnamely, peak atrial longitudinal strain (PALS) and time-to-peak longitudinal strain (TPLS)—may facilitate the earlier identification of subclinical cardiac dysfunction. Methods This prospective study involved 30 HER2-positive breast cancer patients receiving cancer treatment at a tertiary facility. Echocardiographic measures, such as PALS and TPLS, were assessed using speckle-tracking transthoracic echocardiography at baseline and follow-up. Diagnosis of CTRCD followed established criteria. The analysis of the ROC curve evaluated the diagnostic accuracy of PALS and TPLS. Results PALS exhibited greater diagnostic accuracy than TPLS in identifying CTRCD, achieving an AUC of 0.6392 (95% CI, 0.3192-0.8284; p=0.012) with an optimal cutoff value of ≥32% (sensitivity, 62.5%; 95% CI, 0.2449-0.9148); specificity, 72.7%; 95% CI, 0.4978-0.8927). Conversely, TPLS demonstrated lower diagnostic performance with an AUC of 0.2756 (95% CI, 0.0670-0.4610; p=0.027). Furthermore, no significant differences were observed among demographic factors, chemotherapy regimens, or baseline echocardiographic parameters in relation to the onset of CTRCD (p0.05). There were significantly more individuals diagnosed with CTRCD prescribed cardiovascular medications during subsequent follow-ups 12 (60.0%) vs. 10 (100%); p=0.020), respectively. Conclusion PALS has demonstrated greater efficacy as an early indicator of asymptomatic CTRCD in HER2-positive breast cancer patients compared to TPLS and traditional criteria, such as LVEF and GLS. The integration of PALS into routine echocardiographic assessments may facilitate timely interventions, potentially mitigating the progression of CTRCD and enhancing patient outcomes. Patients diagnosed with CTRCD were subsequently more likely to receive cardioprotection, underscoring the critical importance of early detection.Baseline Characteristics of Study Sample ROC Curve, Cutoff and AUC
Narvasa et al. (Fri,) studied this question.