Cardiotoxicity from cancer therapy has become a leading cause of morbidity and mortality
in cancer survivors. The most commonly used definition is cancer therapeutic related
cardiac dysfunction defined as a left ventricular ejection fraction (LVEF) reduction
of >10%, to a value below 50%. However, according to the recent American and European
Society of Echocardiography, global longitudinal strain (GLS) is the optimal parameter
for early detection of subclinical left ventricular dysfunction. The objective of
this study was to evaluate the frequency of GLS reduction in patients with active
cancer and its correlation to other echocardiographic parameters. Data were collected
as part of the International Cardio-Oncology Registry. All patients performed at least
2 echocardiograms including GLS. We evaluated the frequency of GLS reduction (≥10%
relative reduction), its correlation to LVEF reduction and whether there are other
predicting echocardiographic parameters. In 64 consecutive patients, 12 (19%) had
≥10% GLS relative reduction, of which 75% had no concomitant ejection fraction reduction.
There were no significant differences in the baseline cardiac risk factors (hypertension,
diabetes, hyperlipidemia, or smoking). Treatment with Doxorubicin, Pertuzumab, or
Ifosfamide was significantly more frequent in patients GLS reduction. No other echocardiographic
parameters, including diastolic function or systolic pulmonary artery pressure were
significant predictors for GLS reduction. In conclusion, our study demonstrates that
GLS reduction is frequent in active cancer patients, precedes LVEF reduction and cannot
be anticipated by other echocardiographic parameters. Using GLS routinely during therapy
may lead to an early diagnosis of cardiotoxicity.
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Article info
Publication history
Published online: August 20, 2018
Accepted:
August 2,
2018
Received in revised form:
July 29,
2018
Received:
May 9,
2018
Footnotes
Department of Cardiology, Tel-Aviv Sourasky Medical Center is affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Funding/Support: No.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
