Global Longitudinal Strain and 3d Echocardiography for Early Detection of Anthracycline-Induced Subclinical Cardiotoxicity: Narrative Review

Introduction and purpose: Anthracyclines are highly effective chemotherapeutic agents but carry a significant risk of dose-dependent cardiac toxicity, often progressing silently before left-ventricular ejection fraction (LVEF) declines. The objective of this review was to evaluate the role of three-dimensional echocardiography (3D-ECHO) and global longitudinal strain (GLS) in the early detection of subclinical anthracycline-induced cardiotoxicity and to compare their diagnostic performance with conventional 2D-LVEF assessment. Methods: A narrative review was conducted using clinical and observational studies indexed in PubMed over the last ten years. Only peer-reviewed human research evaluating anthracycline-induced cardiotoxicity was included. Studies comparing 2D-LVEF with 3D-LVEF and/or global longitudinal strain (GLS), as well as those assessing early markers of subclinical left-ventricular dysfunction, were selected. Extracted data focused on diagnostic effectiveness, time-to-detection of myocardial injury, and prognostic relevance of strain-based parameters. Conclusion: GLS and 3D-echocardiography outperform conventional 2D-LVEF in identifying early, subclinical anthracycline-related cardiotoxicity. GLS provides the highest sensitivity for early myocardial injury, while 3D-STE enhances spatial assessment and detects dysfunction before EF decline. Routine integration of these modalities into cardio-oncology surveillance may enable earlier intervention, prevent irreversible damage, and improve long-term cardiac outcomes.