Journal
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
Volume 18, Issue 4, Pages 392-401Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ehjci/jew223
Keywords
strain; anthracyclines; cardiotoxicity; echocardiography; left ventricular function
Funding
- local DRCI (Delegation a la recherche clinique et a l'innovation)
- Centre Hospitalier de Versailles
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Aims We sought to assess whether global longitudinal strain (GLS) measured early during treatment with anthracyclines (at a cumulative dose of 150 mg/m(2)) can predict subsequent alterations in left ventricular ejection fraction. Methods and 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/m(2) (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. Conclusion GLS greater than -17.45%, obtained after 150 mg/m(2) 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.
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