Speckle Tracking Echocardiography for Detection of Early Myocardial Changes in Patients Treated with Anthracyclines

Background: Anthracyclines, as cancer chemotherapeutic agents, play an undeniable role in treatment of several cancers. As cardiotoxicity is an important adverse reaction of anthracyclines, elucidation of asymptomatic and potentially symptomatic changes in Left Ventricular Ejection Fraction (LVEF) is of significant interest in patients receiving chemotherapy. Objectives: This study aimed to examine the cardiac effects of Adriamycin therapy based on Speckle-Tracking Echocardiography (STE) and early diagnosis of patients at risk of cardiotoxicity. Patients and Methods: This study was conducted on 30 breast cancer patients ( > 18 years old) who were treated with Adriamycin-based chemotherapy. Conventional echocardiography, STE, Electrocardiogram (ECG), and biochemical markers measurements (troponin I and CK-MB) were performed prior to and after chemotherapy. In addition, longitudinal strain analysis was performed via STE using automated functional imaging. Results: Echocardiographic findings showed significant decreases in Ejection Fraction (EF) after the therapy. However, no significant differences were found regarding pulse rate, systolic and diastolic blood pressure, ECG changes, troponin I, and CK-MB after the therapy. Based on the global longitudinal strain, the longitudinal strain was significantly decreased in the patients after the therapy (-22.1 ± 2.1 prior to and -19 ± 2.2 after the therapy, P = 0.001). Conclusions: Cardiotoxicity during the early phase of anthracycline treatment can be detected via STE prior to observation of systolic function deterioration by conventional echocardiography. In fact, anthracycline-induced cardiotoxicity can be observed much earlier via STE compared to conventional echocardiography.