title: Speckle tracking echocardiography predicts early subclinical anthracycline cardiotoxicity in patients with breast cancer.
abstract: OBJECTIVE
  This study aimed to assess the early changes of left ventricular (LV) and right ventricular (RV) mechanics associated with anthracycline treatment for breast cancer and to determine whether two-dimensional speckle tracking echocardiography (2D-STE) analysis could predict chemotherapy-induced cardiotoxicity.
  
  
  BACKGROUND
  Anthracycline generates progressive LV dysfunction associated with a poor prognosis. Early detection of minor change of myocardial mechanics is thus important.
  
  
  METHODS
  Pretreatment (T0), first (T1), and second (T2) on-treatment echocardiograms were available for analysis with 2D-STE. All patients had normal pretreatment left ventricular ejection fraction (LVEF). Cardiotoxicity was defined as a drop in LVEF to ≤53% or an absolute decrease of 10% on a follow-up echocardiogram. Analysis of variance receiver operating curve and area under the curve (AUC) analysis was performed.
  
  
  RESULTS
  Eighty-six patients with breast cancer who received anthracycline treatment were included. Compared with T0, LV and RV global longitudinal strain (GLS), and LV global circumferential strain (GCS) at T1 and T2 were reduced significantly (p < 0.005 for all). There was a significant decrease in the LV GLS with increasing age at both T1 and T2 (p < 0.05 for all). GLS at T1 (AUC 0.83; cutoff -14.06; sensitivity 83%; specificity 84%; p = 0.0033) and at T2 (AUC 0.90; cutoff -13.84; sensitivity 93%; specificity 84%; p < 0.0001) was the strongest indicator of subsequent cardiotoxicity.
  
  
  CONCLUSIONS
  Anthracycline treatment induces early deterioration of LV global longitudinal and circumferential strain, involving also the RV. Early change in the GLS seems to be a good predictor of the development of chemotherapy-induced cardiotoxicity. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:222-230, 2017.
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Xia
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000633:toxicity*; D001943:Breast Neoplasms / Q000188:drug therapy*; D066126:Cardiotoxicity / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging*
chemical_list: D018943:Anthracyclines
keywords: breast cancer; cardiotoxicity; chemotherapy; myocardial mechanics