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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2018; 39(04): 429-435
DOI: 10.4103/ijmpo.ijmpo_114_17
Original Article

Comparison of Conventional and Advanced Echocardiographic Techniques in Early Detection of Cardiotoxicity in Patients Undergoing Cancer Chemotherapy

HN Pradeep
Departments of Cardiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
,
George Rupesh
Departments of Cardiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
,
Thazhath J Anil
Departments of Medical Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
,
Krishnan Geethu
Departments of Cardiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
,
TG Jayakumar
Departments of Cardiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
,
S Khadar Abdul
Departments of Cardiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Context: The assessment of left ventricular ejection fraction (LVEF) is the most important component in prediction and detection of cardiotoxicity in patients undergoing cancer chemotherapy. LVEF may not be sensitive enough to pick the cardiotoxicity early since drop in LVEF occurs in the last and irreversible stage. A 10%–15% early reduction in global longitudinal strain (GLS) by speckle tracking echocardiography proposed to be the earliest indicator of myocardial dysfunction. Aims: The aim of this study was to compare the early detection of cardiotoxicity (at 0 and 3 months) using drop in LVEF with two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), and GLS techniques. Settings and Design: This was a prospective cohort study of patients attending cardiooncology clinic in a tertiary care institute. Subjects and Methods: Newly diagnosed 75 cases of cancer of various etiologies, for whom cardiotoxic chemotherapy drugs has to be used, were included from January 2016 to June 2016. Statistical Analysis Used: Data were analyzed with Pearson’s Chi-square test, mean, standard deviation, and 95% confidence interval. Results: A total of 17 (22.6%) subjects out of 75, had drop in LVEF by GLS (<−18.9%) as compared to 5 (6.6%) in 2DE and 7 (9.3%) in 3DE at 3 months with statistically significant P values (P = 0.0001). In the 17 subjects who had significant fall in GLS at 3 months, the mean GLS was −16.17 ± 1.55% with a significant reduction of 13.48% from baseline. Conclusion: Reduction in GLS preceded decrease in ejection fraction. Early detection allows modification of chemotherapeutic regimens and medical intervention preventing the irreversible cardiac damage.

Keywords

Cardiotoxicity - chemotherapy - global longitudinal strain - left ventricular ejection fraction - speckle tracking echocardiography


Publication History

Article published online:
17 June 2021

© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C. et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): An analysis of population-based cancer registry data. Lancet 2011; 377: 127-38
    CrossrefPubMedGoogle Scholar
  • 2 International Agency for Research on Cancer. World Cancer Fact Sheet. Geneva, Switzerland: World Health Organization; 2012. Available from: http://www.gicr.iarc.fr/files/resources/20120906-WorldCancerFactSheet.pdf. [Last accessed on 2013 Sep 01].
    Google Scholar
  • 3 Hooning MJ, Botma A, Aleman BM, Baaijens MH, Bartelink H, Klijn JG. et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 2007; 99: 365-75
    CrossrefPubMedGoogle Scholar
  • 4 Doyle JJ, Neugut AI, Jacobson JS, Grann VR, Hershman DL. Chemotherapy and cardiotoxicity in older breast cancer patients: A population-based study. J Clin Oncol 2005; 23: 8597-605
    CrossrefPubMedGoogle Scholar
  • 5 Tan C, Tasaka H, Yu KP, Murphy ML, Karnofsky DA. Daunomycin, an antitumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with special reference to childhood leukemia. Cancer 1967; 20: 333-53
    CrossrefPubMedGoogle Scholar
  • 6 Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL. et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000; 342: 1077-84
    CrossrefPubMedGoogle Scholar
  • 7 Negishi K, Negishi T, Haluska BA, Hare JL, Plana JC, Marwick TH. et al. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging 2014; 15: 324-31
    CrossrefPubMedGoogle Scholar
  • 8 Khouri MG, Douglas PS, Mackey JR, Martin M, Scott JM, Scherrer-Crosbie M. et al. Cancer therapy-induced cardiac toxicity in early breast cancer: Addressing the unresolved issues. Circulation 2012; 126: 2749-63
    CrossrefPubMedGoogle Scholar
  • 9 Martín M, Esteva FJ, Alba E, Khandheria B, Pérez-Isla L, García-Sáenz JA. et al. Minimizing cardiotoxicity while optimizing treatment efficacy with trastuzumab: Review and expert recommendations. Oncologist 2009; 14: 1-11
    CrossrefPubMedGoogle Scholar
  • 10 Yuan DD, Zhu ZX, Zhang X, Liu J. Targeted therapy for gastric cancer: Current status and future directions (Review). Oncol Rep 2016; 35: 1245-54
    CrossrefPubMedGoogle Scholar
  • 11 Zhang S, Liu X, Bawa-Khalfe T, Lu LS, Lyu YL, Liu LF. et al. Identification of the molecular basis of doxorubicin-induced cardiotoxicity. Nat Med 2012; 18: 1639-42
    CrossrefPubMedGoogle Scholar
  • 12 Friedman MA, Bozdech MJ, Billingham ME, Rider AK. Doxorubicin cardiotoxicity. serial endomyocardial biopsies and systolic time intervals. JAMA 1978; 240: 1603-6
    CrossrefPubMedGoogle Scholar
  • 13 Ewer MS, Lippman SM. Type II chemotherapy-related cardiac dysfunction: Time to recognize a new entity. J Clin Oncol 2005; 23: 2900-2
    CrossrefPubMedGoogle Scholar
  • 14 Suter TM, Ewer MS. Cancer drugs and the heart: Importance and management. Eur Heart J 2013; 34: 1102-11
    CrossrefPubMedGoogle Scholar
  • 15 Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A. et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 2001; 344: 783-92
    CrossrefPubMedGoogle Scholar
  • 16 Daher IN, Kim C, Saleh RR, Plana JC, Yusuf SW, Banchs J. et al. Prevalence of abnormal echocardiographic findings in cancer patients: A retrospective evaluation of echocardiography for identifying cardiac abnormalities in cancer patients. Echocardiography 2011; 28: 1061-7
    CrossrefPubMedGoogle Scholar
  • 17 Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL. et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: Summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography). J Am Soc Echocardiogr 2003; 16: 1091-110
    CrossrefPubMedGoogle Scholar
  • 18 American College of Cardiology Foundation Appropriate Use Criteria Task Force. American Society of Echocardiography. American Heart Association. American Society of Nuclear Cardiology. Heart Failure Society of America. Heart Rhythm Society. et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology foundation appropriate use criteria task force, American Society of Echocardiography, American heart association, American society of nuclear cardiology, heart failure society of America, heart rhythm society, society for cardiovascular angiography and interventions, society of critical care medicine, society of cardiovascular computed tomography, society for cardiovascular magnetic resonance American college of chest physicians. J Am Soc Echocardiogr 2011; 24: 229-67
    CrossrefPubMedGoogle Scholar
  • 19 Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA. et al. Recommendations for chamber quantification: A report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-63
    CrossrefPubMedGoogle Scholar
  • 20 Lancellotti P, Badano LP, Lang RM, Akhaladze N, Athanassopoulos GD, Barone D. et al. Normal reference ranges for echocardiography: Rationale, study design, and methodology (NORRE study). Eur Heart J Cardiovasc Imaging 2013; 14: 303-8
    CrossrefPubMedGoogle Scholar
  • 21 Seidman A, Hudis C, Pierri MK, Shak S, Paton V, Ashby M. et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 2002; 20: 1215-21
    CrossrefPubMedGoogle Scholar
  • 22 Jacobs LD, Salgo IS, Goonewardena S, Weinert L, Coon P, Bardo D. et al. Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. Eur Heart J 2006; 27: 460-8
    CrossrefPubMedGoogle Scholar
  • 23 Otterstad JE, Froeland G, St John Sutton M, Holme I. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur Heart J 1997; 18: 507-13
    CrossrefPubMedGoogle Scholar
  • 24 Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popović ZB, Marwick TH. et al. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: Application to patients undergoing cancer chemotherapy. J Am Coll Cardiol 2013; 61: 77-84
    CrossrefPubMedGoogle Scholar
  • 25 Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G. et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol 2010; 55: 213-20
    CrossrefPubMedGoogle Scholar
  • 26 Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M. et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014; 15: 1063-93
    CrossrefPubMedGoogle Scholar
  • 27 Armstrong GT, Plana JC, Zhang N, Srivastava D, Green DM, Ness KK. et al. Screening adult survivors of childhood cancer for cardiomyopathy: Comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol 2012; 30: 2876-84
    CrossrefPubMedGoogle Scholar
  • 28 Mor-Avi V, Lang RM. Is echocardiography reliable for monitoring the adverse cardiac effects of chemotherapy?. J Am Coll Cardiol 2013; 61: 85-7
    CrossrefPubMedGoogle Scholar
  • 29 Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S, Gentile F. et al. Assessment of myocardial mechanics using speckle tracking echocardiography: Fundamentals and clinical applications. J Am Soc Echocardiogr 2010; 23: 351-69
    CrossrefPubMedGoogle Scholar
  • 30 Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: A systematic review. J Am Coll Cardiol 2014; 63: 2751-68
    CrossrefPubMedGoogle Scholar
  • 31 Armstrong WF, Ryan T. Evaluation of systolic function of the left ventricle. Feigenbaum’s Echocardiography. Wolters Kluwer (India) Pvt. Ltd. 7th ed. New Delhi: Lippincott Williams & Wilkins; 2011: 123-58
    Google Scholar
  • 32 Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G. et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese society of echocardiography. Eur J Echocardiogr 2011; 12: 167-205
    CrossrefPubMedGoogle Scholar
  • 33 Ganame J, Claus P, Eyskens B, Uyttebroeck A, Renard M, D’hooge J. et al. Acute cardiac functional and morphological changes after anthracycline infusions in children. Am J Cardiol 2007; 99: 974-7
    CrossrefPubMedGoogle Scholar
  • 34 Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Cohen V. et al. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. Am J Cardiol 2011; 107: 1375-80
    CrossrefPubMedGoogle Scholar
  • 35 Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: A meta-analysis. J Am Soc Echocardiogr 2013; 26: 185-91
    CrossrefPubMedGoogle Scholar
  • 36 Negishi K, Negishi T, Hare JL, Haluska BA, Plana JC, Marwick TH. et al. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr 2013; 26: 493-8
    CrossrefPubMedGoogle Scholar
  • 37 Tarr A, Stoebe S, Tuennemann J, Baka Z, Pfeiffer D, Varga A. et al. Early detection of cardiotoxicity by 2D and 3D deformation imaging in patients receiving chemotherapy. Echo Res Pract 2015; 2: 81-8
    CrossrefPubMedGoogle Scholar
  • 38 Motoki H, Koyama J, Nakazawa H, Aizawa K, Kasai H, Izawa A. et al. Torsion analysis in the early detection of anthracycline-mediated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 13: 95-103
    CrossrefPubMedGoogle Scholar
  • 39 Cadeddu C, Piras A, Mantovani G, Deidda M, Dessì M, Madeddu C. et al. Protective effects of the angiotensin II receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stress, and early ventricular impairment. Am Heart J 2010; 160: 487.e1-7
    CrossrefPubMedGoogle Scholar
  • 40 Mantovani G, Madeddu C, Cadeddu C, Dessì M, Piras A, Massa E. et al. Persistence, up to 18 months of follow-up, of epirubicin-induced myocardial dysfunction detected early by serial tissue Doppler echocardiography: Correlation with inflammatory and oxidative stress markers. Oncologist 2008; 13: 1296-305
    CrossrefPubMedGoogle Scholar
  • 41 Baratta S, Damiano M, Marchese M, Trucco J, Rizzo M, Bernok F. et al. Serum markers, conventional Doppler echocardiography and two-dimensional systolic strain in the diagnosis of chemotherapy-induced myocardial toxicity. Rev Argent Cardiol 2013; 81: 151-8
    Google Scholar
  • 42 Stoodley PW, Richards DA, Boyd A, Hui R, Harnett PR, Meikle SR. et al. Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy. Eur Heart J Cardiovasc Imaging 2013; 14: 228-34
    CrossrefPubMedGoogle Scholar
  • 43 Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC. et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging 2012; 5: 596-603
    CrossrefPubMedGoogle Scholar
  • 44 Kocabay G, Muraru D, Peluso D, Cucchini U, Mihaila S, Padayattil-Jose S. et al. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults. Rev Esp Cardiol (Engl Ed) 2014; 67: 651-8
    CrossrefPubMedGoogle Scholar
  • 45 Takigiku K, Takeuchi M, Izumi C, Yuda S, Sakata K, Ohte N. et al. Normal range of left ventricular 2-dimensional strain: Japanese ultrasound speckle tracking of the left ventricle (JUSTICE) study. Circ J 2012; 76: 2623-32
    CrossrefPubMedGoogle Scholar