title: Reversibility of Left Ventricle Longitudinal Strain Alterations Induced by Adjuvant Therapy in Early Breast Cancer Patients.
abstract: Left ventricular ejection fraction (LV-EF), despite its high feasibility, is not sensitive enough to detect early and subtle LV systolic dysfunction during oncologic treatments. Therefore, we used systolic global longitudinal strain (GLS) by speckle tracking echocardiography to verify whether early LV systolic dysfunction induced by adjuvant therapy in early breast cancer patients at low risk for cardiotoxicity can be reversed. Thirty patients (aged 53 ± 11 y) with no previous cardiac and oncologic disease who were receiving adjuvant trastuzumab and taxane (group HER2+, n = 15) or taxane only (group HER2-, n = 15), after treatment with anthracyclines, were studied. LV-EF and GLS were measured at baseline, after anthracyclines (end of week 7 or 8), short term after trastuzumab and/or taxane (end of week 18) and after completion of therapy. Significant LV systolic dysfunction was defined as a relative reduction in GLS of >10% with respect to baseline values. Mean and individual LV-EFs did not change significantly during the oncologic treatment and after completion of therapy, although GLS varied significantly. In particular, during the course of therapy, four patients in the trastuzumab-docetaxel HER2+ subgroup and two patients in the taxane HER2- subgroup had a relative decrease (>10%) in GLS. However, after the end of adjuvant treatment, strain modification was fully or partially reversible. Speckle tracking echocardiography is more sensitive than LV-EF in recognizing subtle myocardial impairment during adjuvant chemotherapy. However, in patients at low risk for cardiotoxicity, these alterations may be reversible and not associated with clinically significant cardiotoxicity or late development of decreased LV-EF.
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. Electronic address: donatomele@libero.it.
authors.forename: Donato
authors.initials: D
authors.lastname: Mele
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Malagutti
authors.affiliation: Department of Oncology, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Indelli
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ferrari
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Casadei
authors.affiliation: Department of Oncology, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Da Ros
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pollina
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiorencis
authors.affiliation: Department of Oncology, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Frassoldati
authors.affiliation: Department of Cardiology and LTTA Center, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001952:Bridged-Ring Compounds / Q000009:adverse effects / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D043823:Taxoids / Q000009:adverse effects / Q000627:therapeutic use; D000068878:Trastuzumab / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane; D000068878:Trastuzumab
keywords: Cardiotoxicity; Early breast cancer; Echocardiography; Strain; Trastuzumab