Global Longitudinal Strain as Predictor of Chemotherapy-Induced Cardiotoxicity
Authors:   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor), Department of Heart Failure, Samuel Avila Monica , Lofrano Alves Marco Stephan ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor) do Hospital das Clínicas, Moreira Ayub-Ferreira Silvia ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor), Department of Heart Failure, de Barros Wanderley Junior Mauro Rogerio ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor), Department of Heart Failure, das Dores Cruz Fatima ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor), Department of Heart Failure, Gonçalves Brandão Sara Michelly ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor), Department of Heart Failure, Abrahão Hajjar Ludhmila ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor) do Hospital das Clínicas,   Cancer Institute do Estado de São Paulo (USP), Kalil Filho Roberto ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor) do Hospital das Clínicas,   Cancer Institute do Estado de São Paulo (USP), Bittencourt Viana Cruz Cecilia Beatriz ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor) do Hospital das Clínicas,   Cancer Institute do Estado de São Paulo (USP), Abduch Maria Cristina ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor) do Hospital das Clínicas, Bora Moleta Danilo ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor) do Hospital das Clínicas, Bocchi Edimar Alcides ,   Universidade de São Paulo, Faculdade de Medicina, Heart Institute (InCor), Department of Heart Failure
Published: December 2022

Background: Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing ChC. Left ventricular global longitudinal strain (LV-GLS) is a sensitive parameter for detecting systolic dysfunction despite the presence of preserved left ventricular ejection fraction (LVEF). Objective: To evaluate the role of the LV-GLS as a predictor of ChC. Methods: This was a post-hoc analysis of the Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity trial, which evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population of patients with breast cancer. Cardiotoxicity was defined as a reduction ≥10% in LVEF. LV-GLS was determined before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results: Thirty-one patients for whom a complete echocardiography study including measurement of LV-GLS was performed before chemotherapy were included in this analysis. An absolute LV-GLS<16.9% before chemotherapy showed 100% sensitivity and 73% specificity for predicting cardiotoxicity (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.680–0.959; p<0.001). In this population, LVEF values before chemotherapy did not predict ChC (95% CI, 0.478 to -0.842; p=0.17). The association of low LV-GLS (<17%) and brain-type natriuretic peptide serum levels (>17 pg/mL) at 2 months after chemotherapy increased the accuracy for detecting early-onset ChC (100% sensitivity, 88% specificity; AUC, 0.94; 95% CI, 0.781–0.995; p<0.0001). Conclusions: Our data suggest that LV-GLS is a potential predictor of ChC. Larger studies are needed to confirm its clinical relevance in this clinical setting.