title: Two-dimensional myocardial strain imaging detects changes in left ventricular systolic function immediately after anthracycline chemotherapy.
abstract: OBJECTIVE
  The efficacy of anthracyclines is undermined by potential life-threatening cardiotoxicity. Cardiotoxicity is dependent upon several factors and the timing to its development is variable. Moreover, as adjuvant therapy with trastuzumab often follows, a close monitoring of cardiac function in those treated with anthracyclines is mandatory. Left ventricular ejection fraction (LVEF) by echocardiography is currently used for monitoring cardiotoxicity; however, LVEF has numerous limitations. Two-dimensional strain imaging may provide a more sensitive measure of altered LV systolic function, so the aim of the present study was to compare LVEF and LV systolic strain before and after anthracyclines.
  
  
  RESULTS
  Fifty-two women with histologically confirmed breast cancer were prospectively studied. Echocardiographic LVEF (by Simpson's method), global and regional peak longitudinal, radial, and circumferential 2D systolic strain were measured 1 week before and 1 week after chemotherapy. Global and regional longitudinal LV systolic strain was significantly reduced after treatment; global longitudinal strain decreased from -17.7 to -16.3% (P < 0.01) with 48% of global measurements reduced by >10%. Global and regional radial LV systolic strain after treatment was also significantly reduced; global radial strain dropped from 40.5 to 34.5% (P < 0.01) with 59% of global measurements reduced by >10%. In contrast, no reduction in LVEF >10% after chemotherapy was observed.
  
  
  CONCLUSIONS
  Reduced LV systolic strain immediately after anthracycline treatment may indicate early impairment of myocardial function before detectable change in LVEF.
authors.affiliation: Faculty of Health Science, University of Sydney, Lidcombe Campus, 75 East Street, Lidcombe, NSW 2141, Australia. pwstoodley@gmail.com
authors.forename: Paul W
authors.initials: PW
authors.lastname: Stoodley
authors.forename: David A B
authors.initials: DA
authors.lastname: Richards
authors.forename: Rina
authors.initials: R
authors.lastname: Hui
authors.forename: Anita
authors.initials: A
authors.lastname: Boyd
authors.forename: Paul R
authors.initials: PR
authors.lastname: Harnett
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meikle
authors.forename: Jillian
authors.initials: J
authors.lastname: Clarke
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000704:Analysis of Variance; D018943:Anthracyclines / Q000009:adverse effects*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D009206:Myocardium; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D018943:Anthracyclines