Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy.
Echocardiography. 2024 Aug;41(8):e15881. doi: 10.1111/echo.15881.
Recently, peak atrial longitudinal strain (PALS) has emerged as a possible predictor of Cancer therapy-related cardiac dysfunction (CTRCD) in cancer patients (CP), in addition to left ventricular global longitudinal strain (GLS). Thus, considering the link between left atrium and left ventricle, the aim of this study was to assess the global atrio-ventricular strain (GAVS) in CP, to detect early cardiotoxicity.
A prospective study was carried out enrolling 131 breast cancer women (mean age 51.4 ± 10.4 years) receiving anti-cancer treatment. Clinical and echocardiographic evaluation was performed at baseline (T0), 3 (T1), 6 (T2) and 12 months (T3) after starting treatment. CTRCD was defined according to the 2022 ESC Cardio-Oncology guidelines.
Forty-four patients developed CTRCD (3 moderate and 41 mild CTRCD group A) and 87 patients did not (group B). In group A, significant changes in GLS, PALS, GAVS, LASi (left atrial stiffness index) and LVEF/GLS occurred earlier than LVEF, that reduced significantly only at T3 (p-value < .05). Significant changes in LASi, PALS and GAVS occurred even in group B but reduction in GAVS (-21% vs. -5%) and PALS (-24% vs. -12%) was significantly greater in group A compared to group B (p-value = .04).
Our study confirms high sensitivity of speckle tracking echocardiography in detecting subclinical myocardial damage in CP and the usefulness of a multiparametric echocardiographic evaluation including PALS and GLS (GAVS) for having a global evaluation of the phenomenon cardiotoxicity.
最近，峰心房纵向应变（PALS）已成为癌症患者（CP）癌症治疗相关心脏功能障碍（CTRCD）的可能预测因子，除了左心室整体纵向应变（GLS）。因此，考虑到左心房和左心室之间的联系，本研究旨在评估 CP 中的整体房室应变（GAVS），以检测早期心脏毒性。
进行了一项前瞻性研究，共纳入 131 名接受抗癌治疗的乳腺癌女性（平均年龄 51.4±10.4 岁）。在开始治疗后 3（T1）、6（T2）和 12 个月（T3）时进行临床和超声心动图评估。根据 2022 年 ESC 心脏肿瘤学指南定义 CTRCD。
44 例患者发生 CTRCD（3 例中度和 41 例轻度 CTRCD 组 A），87 例患者未发生（组 B）。在组 A 中，GLS、PALS、GAVS、LASi（左心房僵硬度指数）和 LVEF/GLS 的变化早于 LVEF，仅在 T3 时显著降低（p 值<.05）。即使在组 B 中也观察到 LASi、PALS 和 GAVS 的变化，但与组 B 相比，组 A 中的 GAVS（-21%比-5%）和 PALS（-24%比-12%）的降低更为显著（p 值=.04）。
我们的研究证实，斑点追踪超声心动图在检测 CP 亚临床心肌损伤方面具有很高的敏感性，并且包括 PALS 和 GLS（GAVS）在内的多参数超声心动图评估对于全面评估心脏毒性现象非常有用。
