title: Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy for the prediction of subsequent cardiotoxicity.
abstract: OBJECTIVE
  The aim of this study was to assess whether global longitudinal strain (GLS) measured early during treatment with anthracycline (at a cumulative dose of 150mg/m2) can predict subsequent alterations in left ventricular ejection fraction (LVEF).
  
  
  RESULTS
  Eighty-six patients suffering from Hodgkin's disease, non-Hodgkin's lymphoma or acute leukemia and receiving anthracyclines were prospectively included. They underwent complete echocardiography on four separate occasions: baseline (V1); after reaching a cumulative dose of 150mg/m2(V2); end of treatment (V3); one year follow-up (V4). Six patients developed cardiotoxicity defined by a decrease in LVEF by more than 10 percentage points to a value of at least less than 53% at V4. Both GLS measured at V1 and at V2 were significantly lower in the cardiotoxicity group compared with the control group (P=0.042 and P=0.01, respectively). Compared to GLS at V1, GLS obtained at V2 provided implemental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver operating characteristic curve, 0.823). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95%CI: [33-100%]) and 97% (95%CI: [94-100%]) respectively.
  
  
  CONCLUSIONS
  GLS>-17.45%, obtained after 150mg/m2of anthracycline therapy, is a significant predictor of future anthracycline-induced cardiotoxicity. This study should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.
authors.affiliation: Cardiologie, centre hospitalier, 78000 Versailles, France. Electronic address: clementcharbonnel@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Charbonnel
authors.affiliation: Cardiologie, centre hospitalier, 78000 Versailles, France.
authors.forename: R
authors.initials: R
authors.lastname: Convers-Domart
authors.affiliation: Hématologie, centre hospitalier, 78000 Versailles, France.
authors.forename: S
authors.initials: S
authors.lastname: Rigaudeau
authors.affiliation: Hématologie, centre hospitalier, 78000 Versailles, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Taksin
authors.affiliation: Cardiologie, centre hospitalier, 78000 Versailles, France.
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authors.initials: N
authors.lastname: Baron
authors.affiliation: Hématologie, centre hospitalier, 78000 Versailles, France.
authors.forename: J
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Hématologie, centre hospitalier, 78000 Versailles, France.
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authors.initials: S
authors.lastname: Ghez
authors.affiliation: Cardiologie, centre hospitalier, 78000 Versailles, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Georges
authors.affiliation: Hématologie, centre hospitalier, 78000 Versailles, France.
authors.forename: H
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authors.lastname: Farhat
authors.affiliation: Département de biostatistique, AP-HP Saint-Louis, 75010 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Hématologie, centre hospitalier, 78000 Versailles, France.
authors.forename: P
authors.initials: P
authors.lastname: Rousselot
authors.affiliation: Cardiologie, centre hospitalier, 78000 Versailles, France.
authors.forename: B
authors.initials: B
authors.lastname: Livarek