title: Subclinical ventricular dysfunction detected by speckle tracking two years after use of anthracycline.
abstract: BACKGROUND
  Heart failure is a severe complication associated with doxorubicin (DOX) use. Strain, assessed by two-dimensional speckle tracking (2D-STE), has been shown to be useful in identifying subclinical ventricular dysfunction.
  
  
  OBJECTIVE
  a) To investigate the role of strain in the identification of subclinical ventricular dysfunction in patients who used DOX; b) to investigate determinants of strain response in these patients.
  
  
  METHODS
  Cross-sectional study with 81 participants: 40 patients who used DOX ± 2 years before the study and 41 controls. All participants had left ventricular ejection fraction (LVEF) ≥ 55%. Total dose of DOX was 396 mg (242 mg/ms2). The systolic function of the LV was evaluated by LVEF (Simpson), as well as by longitudinal (εLL), circumferential (εCC), and radial (εRR) strains. Multivariate linear regression (MLR) analysis was performed using εLL (model 1) and εCC (model 2) as dependent variables.
  
  
  RESULTS
  Systolic and diastolic blood pressure values were higher in the control group (p < 0.05). εLL was lower in the DOX group (-12.4 ± 2.6%) versus controls (-13.4 ± 1.7%; p = 0.044). The same occurred with εCC: -12.1 ± 2.7% (DOX) versus -16.7 ± 3.6% (controls; p < 0.001). The S' wave was shorter in the DOX group (p = 0.035). On MLR, DOX was an independent predictor of reduced εCC (B = -4.429, p < 0.001). DOX (B = -1.289, p = 0.012) and age (B = -0.057, p = 0.029) were independent markers of reduced εLL.
  
  
  CONCLUSIONS
  a) εLL, εCC and the S' wave are reduced in patients who used DOX ± 2 years prior to the study despite normal LVEF, suggesting the presence of subclinical ventricular dysfunction; b) DOX was an independent predictor of reduced εCC; c) prior use of DOX and age were independent markers of reduced εLL.
authors.affiliation: Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: André Luiz Cerqueira
authors.initials: AL
authors.lastname: de Almeida
authors.affiliation: Hospital Dom Pedro de Alcântara, Santa Casa de Misericórdia de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Viviane Almeida
authors.initials: VA
authors.lastname: Silva
authors.affiliation: Hospital Dom Pedro de Alcântara, Santa Casa de Misericórdia de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Alberto Teófilo
authors.initials: AT
authors.lastname: de Souza Filho
authors.affiliation: Hospital Dom Pedro de Alcântara, Santa Casa de Misericórdia de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Vinicius Guedes
authors.initials: VG
authors.lastname: Rios
authors.affiliation: Hospital Dom Pedro de Alcântara, Santa Casa de Misericórdia de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: João Ricardo Pinto
authors.initials: JR
authors.lastname: Lopes
authors.affiliation: Unidade de Alta Complexidade em Oncologia, Feira de Santana, BA, Brasil.
authors.forename: Samuel Oliveira
authors.initials: SO
authors.lastname: de Afonseca
authors.affiliation: Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Daniel de Castro Araújo
authors.initials: Dde C
authors.lastname: Cunha
authors.affiliation: Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Murilo Oliveira da Cunha
authors.initials: MO
authors.lastname: Mendes
authors.affiliation: Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Danilo Leal
authors.initials: DL
authors.lastname: Miranda
authors.affiliation: Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.
authors.forename: Edval Gomes
authors.initials: EG
authors.lastname: dos Santos Júnior
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D062186:Arterial Pressure; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004317:Doxorubicin / Q000009:adverse effects*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin