title: Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity.
abstract: OBJECTIVE
  We sought to assess whether global longitudinal strain (GLS) measured early during treatment with anthracyclines (at a cumulative dose of 150 mg/m2) can predict subsequent alterations in left ventricular ejection fraction.
  
  
  RESULTS
  Eighty-six patients with Hodgkin's disease, non-Hodgkin's lymphoma, or acute leukaemia and receiving anthracyclines were prospectively included. Patients underwent complete echocardiography on four occasions: baseline (V1); after reaching a cumulative dose of 150 mg/m2 (V2); end of treatment (V3); and 1 year follow-up (V4). Six patients developed cardiotoxicity, defined as a decrease in left ventricular ejection fraction of >10 percentage points, to a value <53%, at V4. GLS measured at V1 and V2 was significantly lower in the cardiotoxicity group vs. the controls (P = 0.042 and P = 0.01, respectively). Compared with GLS at V1, GLS obtained at V2 provided incremental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver-operating-characteristic curve, 0.82). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95% confidence interval 33-100) and 97% (95% confidence interval 94-100), respectively.
  
  
  CONCLUSIONS
  GLS greater than -17.45%, obtained after 150 mg/m2 of anthracycline therapy, is an independent predictor of future anthracycline-induced cardiotoxicity. These findings should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.
authors.affiliation: Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Charbonnel
authors.affiliation: Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Raphaele
authors.initials: R
authors.lastname: Convers-Domart
authors.affiliation: Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Rigaudeau
authors.affiliation: Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Taksin
authors.affiliation: Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Baron
authors.affiliation: Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Ghez
authors.affiliation: Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Georges
authors.affiliation: Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Hassan
authors.initials: H
authors.lastname: Farhat
authors.affiliation: Department of Biostatistics, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rousselot
authors.affiliation: Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Livarek
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D066126:Cardiotoxicity / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004452:Echocardiography; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging*
chemical_list: D018943:Anthracyclines
keywords: anthracyclines; cardiotoxicity; echocardiography; left ventricular function; strain