GLOBAL LONGITUDINAL STRAIN AS A PREDICTOR OF CARDIOTOXICITY IN BREAST CANCER PATIENTS RECEIVING ANTHRACYCLINE AND/OR TRASTUZUMAB TREATMENT IN A TERTIARY CARE CENTRE IN EASTERN INDIA

AMRITA PAUL; MANISH SAHA; SUBRATA BASU; KOUSTUV CHOWDHURY

doi:10.22159/ajpcr.2025v18i3.53627

Authors

AMRITA PAUL Department of Cardiology, Peerless Hospital, Kolkata, West Bengal, India
MANISH SAHA Department of Cardiology, R G Kar Medical College, Kolkata, West Bengal, India
SUBRATA BASU Department of Cardiology, North Bengal Medical College, Darjeeling, West Bengal, India
KOUSTUV CHOWDHURY Department of Pharmacology, R G Kar Medical College, Kolkata, West Bengal, India. https://orcid.org/0000-0001-5997-5011

DOI:

https://doi.org/10.22159/ajpcr.2025v18i3.53627

Keywords:

Cardiotoxicity, Chemotherapy, Breast carcinoma

Abstract

Objectives: The objective of the study was to find out whether global longitudinal strain (GLS) poses as a novel marker of left ventricular (LV) systolic function and it was to be seen whether GLS could predict cardiotoxicity earlier than Ejection fraction (EF).

Methods: Fifty-two patients set to receive anthracycline and/or trastuzumab-based chemotherapy for breast carcinoma were selected – clinical parameters and baseline echocardiography (EF, E/e,’ LV S,’ Tricuspid annular plane systolic excursion, Pulmonary artery systolic pressure and GLS) were measured and followed up at 3 months and 6 months. The echocardiography profiles of patients with and without cardiotoxicity were compared.

Results: Incidence of cardiotoxicity is found 11.5%. On 3rd month, the mean LV GLS, as well as its difference regarding the baseline value, were significantly higher in the group with cardiotoxicity in comparison to those without cardiotoxicity. On 6th month, there was a significant drop in the EF and LV GLS, E/e’, and LV s’ in the patients with cardiotoxicity. LV GLS on the 3rd month remained an independent predictor of cardiotoxicity, maintaining a statistically significant association in multivariate models.

Conclusion: GLS is indeed a more sensitive marker of LV systolic functions than EF. It predicted cardiotoxicity earlier than EF and accurately. This study also provided a cutoff value for LV GLS at 3 months in predicting who would develop cardiotoxicity at 6 months, so that the chemotherapy regimen could be modified in such patients.

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Author Biography

AMRITA PAUL, Department of Cardiology, Peerless Hospital, Kolkata, West Bengal, India

References

Almaaytah A. Technical guidance on the physicochemical and functional comparability exercise for trastuzumab biosimilars. Int J Appl Pharm. 2022;14(4):71-6. doi: 10.22159/ijap.2022v14i4.44963

Centers for Disease Control and Prevention (CDC). Cancer survivors--United States, 2007. MMWR Morb Mortal Wkly Rep. 2011 Mar 11;60(9):269-72. PMID: 21389929

Schimmel KJ, Richel DJ, van den Brink RB, Guchelaar HJ. Cardiotoxicity of cytotoxic drugs. Cancer Treat Rev. 2004 Apr;30(2):181-91. doi: 10.1016/j.ctrv.2003.07.003, PMID: 15023436

Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: Incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol. 2009 Jun 16;53(24):2231-47. doi: 10.1016/j.jacc.2009.02.050, PMID: 19520246

Seidman A, Hudis C, Pierri MK, Shak S, Paton V, Ashby M, et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol. 2002 Mar 1;20(5):1215-21. doi: 10.1200/JCO.2002.20.5.1215, PMID: 11870163

Florescu M, Magda LS, Enescu OA, Jinga D, Vinereanu D. Early detection of epirubicin-induced cardiotoxicity in patients with breast cancer. J Am Soc Echocardiogr. 2014 Jan;27(1):83-92. doi: 10.1016/j. echo.2013.10.008, PMID: 24268372

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239. doi: 10.1016/j.jacc.2013.05.019, PMID: 23747642

Mohan JC, Mohan V. Tissue doppler and strain imaging: Physical principles and clinical application. In: Amuthan V, Parashar SK, editors. Textbook of Echocardiography. 1st ed. New Delhi: Jaypee Brothers; 2018. p. 188.

Negishi K, Negishi T, Hare JL, Haluska BA, Plana JC, Marwick TH. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr. 2013 May;26(5):493-8. doi: 10.1016/j.echo.2013.02.008, PMID: 23562088

Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: A systematic review. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt A):2751-68. doi: 10.1016/j.jacc.2014.01.073, PMID: 24703918

Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Cohen V, et al. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. Am J Cardiol. 2011 May 1;107(9):1375-80. doi: 10.1016/j. amjcard.2011.01.006, PMID: 21371685, PMCID: PMC3703314

Baratta S, Damiano M, Marchese M, Trucco J, Rizzo M, Bernok F, et al. Serum markers, conventional Doppler echocardiography, and two-dimensional systolic strain in the diagnosis of chemotherapy-induced myocardial toxicity. Rev Argent Cardiol. 2013;81:151-8.