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Global Longitudinal Strain as a Predictor of Chemotherapy-Induced Cardiotoxicity

Background: Chemotherapy-induced cardiotoxicity (ChC) is an important
complication among patients receiving anthracyclines. Biomarkers and
imaging parameters have been studied for their ability to identify
patients at risk of developing this complication. Left ventricle global
longitudinal strain (LV-GLS) has been described as a sensitive parameter
for detecting systolic dysfunction, even in the presence of preserved
left ventricle ejection fraction (LVEF). Objective: to evaluate the role
of the LV-GLS as a predictor of ChC. Methods: This study is a post-hoc
analysis of CECCY trial (Carvedilol for Prevention of
Chemotherapy-Related Cardiotoxicity) that evaluated the primary
prevention of cardiotoxicity with carvedilol during doxorubicin
chemotherapy in a population with breast cancer. Cardiotoxicity was
defined as a reduction >10% in LVEF. LV-GLS was obtained
before chemotherapy in patients with no prior cardiovascular disease or
echocardiogram abnormalities. Results: Thirty-one patients who had a
complete echocardiography study including measurement of LV-GLS before
chemotherapy were included in this analysis. An absolute LV-GLS
<16.9% before chemotherapy showed 100% sensitivity and 73%
specificity for predicting cardiotoxicity (AUC=0.85; 95%CI 0.680 –
0.959, p<0.001). In this population, LVEF values before
chemotherapy did not predict ChC (95%CI 0.478 to -0.842, p=0.17). The
association of low LV-GLS (<17%) and BNP serum levels
(>17 pg/mL) two months after chemotherapy increased the
accuracy for detecting early onset ChC (100% sensitivity, 88%
specificity, AUC=0.94; 95%CI 0.781 – 0.995, p<0.0001).
Conclusions: Our data suggest that LV-GLS is a potential predictor of
chemotherapy-induced cardiotoxicity. Larger studies are needed to
confirm the relevance of this echocardiographic parameter in this
clinical setting.