Role of global left ventricle longitudinal strain and Cardiac Biomarkers
In Early Detection Of Cancer Therapy Related Dysfunction In Patients
Treated with cardiotoxic chemotherapeutic drugs.
Abstract
Background: Cancer therapy– related cardiac dysfunction (CTRCD) is
nowadays a frequently encountered clinical presentation, and
transthoracic echocardiography (TTE) is usually the routine imaging
modality of its screening and detection. The aim is to early detect
subclinical CTRCD using non invasive imaging techniques & cardiac
biomarkers. Methods: Eighty-eight patients with cancer, planned to
receive Anthracyclines(AC) or Trastuzumab (TZB) were enrolled, baseline
screening included 2D TTE, GLS and cardiac troponin I and NtProBNP
measurments before receiving any treatment, follow up at three and six
months were done using the same variables to early detect CTRCD and
start CPT even in cases of mild dysfunction. Results: Twenty six
patients developed CTRCD, 18 had mild and 8 had moderate asymptomatic
CTRCD defined by relative decline in GLS & LVEF following the latest
ESC cardio-oncology guidelines. The percentage of change in GLS from
baseline and at 3 and 6 months was able to detect CTRCD in both groups
in our population which was >16.6% at 3 months with P value
of <0.001*and CI 0.783 – 0.934 and >10.10% at 6
months with P value of of <0.001*and CI 0.765 – 0.935 .At three
months GLS values ≤-18.6 was able to detect CTRCD with P value of of
<0.001*and CI 0.673 0.885.Compared to patients who did not
develop CRTD, patients with mild asymptomatic CTRCD had double levels of
NT-Pro BNP with a median of (99.5 ) ( IQR: 44.0 – 154.0) at 3 months
follow up with P value 0.037 which was normalized at 6 months.
Conclusion: The relative decline of GLS and elevation of NT-proBNP were
able to diagnose patients with subclinical CTRCD in patients receiving
AC with early start of Cardioprotective Treatments (CPT) which enabled
the patients to continue their chemotherapeutic treatment uninterrupted
without developing serious grades of LV dysfunction and even some
patients showed improvement after CPT.