A 10% to 15% early reduction in global longitudinal strain by speckle tracking echocardiography during cancer therapy predicts cardiotoxicity before significant changes in LVEF.
Systematic Review (n=1,504)
Does myocardial strain imaging by echocardiography improve the early detection of cardiotoxicity in patients during and after cancer chemotherapy?
Myocardial strain imaging, specifically a 10-15% reduction in global longitudinal strain, is a valuable tool for the early detection and prediction of chemotherapy-induced cardiotoxicity before LVEF declines.
The literature exploring the utility of advanced echocardiographic techniques (such as deformation imaging) in the diagnosis and prognostication of patients receiving potentially cardiotoxic cancer therapy has involved relatively small trials in the research setting. In this systematic review of the current literature, we describe echocardiographic myocardial deformation parameters in 1,504 patients during or after cancer chemotherapy for 3 clinically-relevant scenarios. The systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the EMBASE (1974 to November 2013) and MEDLINE (1946 to November 2013) databases. All studies of early myocardial changes with chemotherapy demonstrate that alterations of myocardial deformation precede significant change in left ventricular ejection fraction (LVEF). Using tissue Doppler-based strain imaging, peak systolic longitudinal strain rate has most consistently detected early myocardial changes during therapy, whereas with speckle tracking echocardiography (STE), peak systolic global longitudinal strain (GLS) appears to be the best measure. A 10% to 15% early reduction in GLS by STE during therapy appears to be the most useful parameter for the prediction of cardiotoxicity, defined as a drop in LVEF or heart failure. In late survivors of cancer, measures of global radial and circumferential strain are consistently abnormal, even in the context of normal LVEF, but their clinical value in predicting subsequent ventricular dysfunction or heart failure has not been explored. Thus, this systematic review confirms the value of echocardiographic myocardial deformation parameters for the early detection of myocardial changes and prediction of cardiotoxicity in patients receiving cancer therapy.
Thavendiranathan et al. (2014) conducted a systematic review in Cancer chemotherapy-induced cardiotoxicity (n=1,504). Myocardial strain imaging by echocardiography was evaluated on Prediction of cardiotoxicity (drop in LVEF or heart failure). A 10% to 15% early reduction in global longitudinal strain by speckle tracking echocardiography during cancer therapy predicts cardiotoxicity before significant changes in LVEF.