Stress echocardiography and left atrial strain as a method to assess the likelihood of developing atrial fibrillation in patients undergoing anticancer therapy as a manifestation of cardiotoxicity
Authors: Samardjieva M , Simova I , Sirakov M , Petrusheva V , Chilingirova N , Vekov T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The manifestation of cardiotoxicity in patients undergoing anticancer therapy is one of the main side effects.By examining laboratory indicators such as NTproBNP and troponin, as well as by maximally sparing imaging methods such as echocardiography, the determination of left ventricular(LV) and left atrial(LA) strain,and in particular stress echocardiography(SE),a complete picture of the patient's cardiovascular status is obtained and can be used to detect subclinical cardiotoxicity.Based on the listed methods,a well-recorded history of cardiovascular diseases and risk factors, the risk of development and manifestation of cardiotoxicity can be determined.Evaluation and follow-up of cancer patients before,during and after chemo,targeted,immune and radiotherapy is of utmost importance for timely detection and prevention of the development of cardiotoxicity.Purpose:To prove the importance of LA strain(at rest and during SE)as a predictor for the manifestation of atrial fibrillation.Methods:In a group of 11 patients diagnosed with: invasive breast cancer, HER-2 positive, after 25 courses of radiotherapy(6 patients), ovarian cancer(1 patient), stomach cancer(2 patients),lung cancer (1 patient), and Testicular cancer(1 patient), SE was performed before initiation of antitumor therapy with assessment of LV ejection fraction(EF),global longitudinal strain(GLS),LA volumes,dimensions,area and strain,as well as assessment of diastolic function.All eleven patients had no history of rhythm disorders and were with sinus rhythm on initial ECG.Up till now 4 of the patients have been followed up for 3 months after starting targeted therapy.Troponin and NTproBNP were measured. Based on the obtained results,the risk of developing cardiotoxicity was determined,thanks to which the selection of antitumor therapy,as well as the correct dosage, was specified in a cardio-oncology team.Results: We included 8 women and 3 men;average age of 47.7 years(+/-12).Mean pre-chemotherapy ejection fraction at rest/during SE was 67.5%/73.5% (+/-7.2%/+/- 5.3%), mean GLS: -17.6%/-16.7% (+/-3.9%/+/-2.2%), respectively. At rest LA volume was 31.4ml(+/-5.11ml),with an LA strain in the reservoir phase of 23.4%( +/- 4.5%).During SE LA strain increased to 30.1%(+/-8.2%), while LA volume remained relatively unchanged 33ml(+/-8.98ml).During the the 3-month follow-up of after initiation of anticancer therapy, one of the patients had a first manifestation of atrial fibrillation.In this patient,baseline LA reservoir strain was slightly reduced at rest but significantly improved under stress 27.9%/41.2%.Conclusions:Patients undergoing anticancer therapy are at high risk of developing cardiotoxicity, manifested in different ways with the appearance of arrythmias,manifestations of heart failure,ischemic heart disease.Regular follow-up by cardiologists during anticancer therapy is of great importance to achieve a longer life expectancy and reduce the risk of developing cardiotoxicity.