title: 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancer patients: a balance with feasibility.
abstract: OBJECTIVE
  2D echocardiography is limited for identifying chemotherapy-related cardiotoxicity. This study compared standard echo, 2D, and 3D speckle tracking echocardiography (STE) for detection of subclinical anthracycline (ANT) cardiotoxicity in breast cancer patients.
  
  
  RESULTS
  One-hundred consecutive breast cancer patients free of cardiac symptoms were treated by multiple protocols including ANT and cyclophosphamide and/or 5-fluorouracil for 3-4 cycles. Both before and after treatment, patients underwent standard echo, 2D STE-derived left ventricular (LV) global longitudinal strain (GLS), 3D volumetric echo and 3D STE with measurements of GLS, global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS). The follow-up period from the beginning of cancer therapy was 129 ± 18 days. All patients completed the chemotherapy cycles, without experiencing symptoms/signs of heart failure. 2D ejection fraction (EF) was not significantly changed after treatment, whereas E/e' ratio was higher than baseline (from 6.9 ± 2.2 to 7.3 ± 2.1, P = 0.006). 2D GLS was reduced after treatment (from -22.2 ± 2.3% to - 20.1 ± 6.6%, P = 0.004). 3D derived LV end-systolic volume was increased (P < 0.01) and 3D EF (from 62.4 ± 6.5% to 60.3 ± 7.3%, P < 0.01), 3D GLS (P < 0.001) GRS (P < 0.002), GCS, and GAS (both P < 0.0001) were reduced after ANT. Post-ANT 2D GLS was feasible in 90%, 3D EF in 66%, and 3D STE in 60% of patients.
  
  
  CONCLUSIONS
  Our study demonstrates potential superiority but also suboptimal feasibility of 3D EF and 3D strain in diagnosing subclinical ANT cardiotoxicity in breast cancer patients. 2D GLS is superior to standard echo and presents a good feasibility. E/e' ratio also offers advantages in revealing cardiotoxicity.
authors.affiliation: Department of Advanced Biomedical Science, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Santoro
authors.affiliation: Department of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Arpino
authors.affiliation: Department of Advanced Biomedical Science, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Esposito
authors.affiliation: Department of Advanced Biomedical Science, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Lembo
authors.affiliation: Department of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Immacolata
authors.initials: I
authors.lastname: Paciolla
authors.affiliation: Department of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Cardalesi
authors.affiliation: Department of Medical Translational Science, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.affiliation: Department of Advanced Biomedical Science, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Department of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: De Placido
authors.affiliation: Department of Advanced Biomedical Science, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
mesh_terms: D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D066126:Cardiotoxicity / Q000000981:diagnostic imaging* / Q000209:etiology; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; 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; D000903:Antibiotics, Antineoplastic
keywords: anthracycline ; ejection fraction ; global longitudinal strain ; left ventricular filling pressure ; real-time 3D echocardiography;  breast cancer 