Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. The aim of this observational study is to analyse some echocardiographic (echo) features of patients affected by cancer evaluated in our laboratory.
Methods: We studied patients who came to our laboratory for echo assessment of potential chemotherapeutic cardiotoxicity in October and November 2022. We performed complete echocardiograms (Philips Epiq 7) with a focus on systolic (left ventricular ejection fraction, LVEF and GLS) and diastolic function.
Results: Over the study period, 112 cancer patients underwent echo. Twenty-six patients waiting to start radio/chemotherapy were excluded from analysis. Twenty patients were excluded due to poor quality of echo images. The majority of patients were female (92%, mean age 61.9 years). The predominant type of cancer was breast cancer (78%), followed by prostate cancer (4%), ovarian cancer (2%), and lymphoma (2%). No patients had signs or symptoms of heart failure. Twenty-three patients had a history of hypertension, 3 had diabetes mellitus, and 1 had coronary artery disease (Table 1). We separately evaluated patients according to cancer treatment. Twenty-four patients (28%) had been treated with anthracycline (AT), 3 patients (3%) had been treated with AT in combination with trastuzumab, 9 patients (10%) had been treated with trastuzumab monotherapy, 25 patients (29%) had been treated with left chest radiotherapy (RT) and were currently undergoing hormone therapy (HT), and 25 patients (29%) had been treated with other chemotherapy (CT), specifically tyrosine kinase inhibitors, anti VEGF-drugs, taxanes, and antimetabolites. No moderate or severe dysfunction was found in the study population, however 52 patients (60%) had mild diastolic dysfunction. The mean EF value was 63% and the mean GLS value was 17.4% (Table 2). Ten patients had reduced GLS values (< 16%) with normal EF. Of these patients, 2 had been treated with AT, 3 with trastuzumab, 2 with HT, and 3 with other CT (Table 3).
Conclusions
According to the literature, GLS assessment during/after cardiotoxic CT could help identify subclinical left ventricular dysfunction. Our data, derived from a short observation period, show mild reduction in GLS in asymptomatic patients treated with different CT, thus suggesting a potential benefit of closer follow-up of these pts.