title: Speckle-tracking global longitudinal strain as an early predictor of cardiotoxicity in breast carcinoma.
abstract: Recent development in anticancer therapies for breast carcinoma allowed an improvement in patients' survival, notwithstanding a parallel increase of cardiovascular morbidity. Cardiotoxicity of anticancer therapies represents a relevant problem due to its insidious onset and potentially irreversible cardiac damage. The aim of the present study was to test whether 2D speckle tracking analysis can help in predicting overt systolic dysfunction.
  
  
  
  A "real world" cohort of 69 patients with breast carcinoma undergoing adjuvant and/or neo-adjuvant chemotherapy was tested 2D-speckle tracking analysis before the beginning of chemotherapy and every 3 months for 1 year. Clinical data, 12-lead ECGs, and lab tests were collected according to the same visit protocol.
  
  
  
  Over 1-year follow-up, 19 patients (27 %) developed cardiac dysfunction according to the CREC criteria, with an average onset time from enrolment of 6.8 months. A global longitudinal strain (GLS) threshold ≥-16 % at 3 months from chemotherapy was able to predict subsequent systolic dysfunction development with high sensitivity (80 %) and specificity (90 %) and a negative predictive value of 92 %. After the introduction of cardioprotective drugs, left ventricular ejection fraction (LVEF) progressively recovered, while alterations of GLS persisted at 1-year follow-up.
  
  
  
  Strain imaging with 2D speckle tracking allows the identification of patients at low-risk for chemotherapy-related systolic dysfunction and can help optimizing resources allocations and improving follow-up quality. GLS can also provide a more accurate prognostic index of resolved systolic dysfunction when compared to standard LVEF.
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy. f.guerra@univpm.it.
authors.forename: Federico
authors.identifier: 0000-0001-5394-1312
authors.initials: F
authors.lastname: Guerra
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marchesini
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Contadini
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Menditto
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Morelli
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Piccolo
authors.affiliation: Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Battelli
authors.affiliation: Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Pistelli
authors.affiliation: Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Berardi
authors.affiliation: Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
authors.forename: Alessando
authors.initials: A
authors.lastname: Capucci
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology; D066126:Cardiotoxicity / Q000175:diagnosis*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
keywords: 2D speckle tracking; Breast carcinoma; Cardiotoxicity; Chemotherapy; Heart failure; Strain analysis