Gorgiladze Nana, Shavdia Mikheil, Gaprindashvili Tamar, Gogua Elene, Gachechiladze Lika, Gujabidze Mata, Pagava Zurab
Department of Clinical Oncology, Tbilisi State Medical University, Tbilisi, GEO.
Department of Cardiopulmonology, Bokhua Memorial Cardiovascular Center, Tbilisi, GEO.
Cureus. 2024 Jun 25;16(6):e63138. doi: 10.7759/cureus.63138. eCollection 2024 Jun.
Objective Breast cancer patients who receive chemotherapy may develop cancer therapy-related cardiovascular toxicity, particularly if they have pre-existing cardiovascular risk factors. Notably, right ventricle dysfunction may manifest before the left ventricle. Our study aims to compare conventional echocardiography with global longitudinal strain (GLS) in low cardiovascular risk patients on low-dose anthracycline, focusing on early cardiotoxicity detection. Additionally, we explore the predictive role of right ventricular free wall longitudinal strain (RVFWLS) in cardiotoxicity. Methods In a recent study, 28 women with low cardiovascular risk who underwent low-dose anthracycline chemotherapy for breast cancer were assessed for cardiac function using two-dimensional echocardiography and speckle-tracking echocardiography. The measurements included left ventricular ejection fraction (LVEF), right ventricular systolic function (RVS'), tricuspid annular plane systolic excursion (TAPSE), left ventricular global longitudinal strain (LVGLS), and RVFWLS. All patients had normal LVEF at the beginning of the study. Cardiotoxicity was defined as a new decrease in LVEF by 10% or below 53% and/or changes in LVGLS/RVFWLS by 15%. Results In our study, no significant changes were observed in the LVEF following chemotherapy treatment. The LVEF values remained stable, changing slightly from 63 ± 3.7 to 65.0 ± 3.4, with a t-test value of 1.790 and a p-value of 0.079. Similarly, the analysis found no significant changes in RVS' and TAPSE values following chemotherapy treatment. However, significant changes were observed in strain measurements. LVGLS decreased from -21.2 ± 2.1 to -18.6 ± 2.6 (t-test = -4.116; df = 54, p=0.001), and RVFWLS decreased from -25.2 ± 2.9 to -21.4 ± 4.4 (t-test = -3.82; df = 54, p=0.001). Notably, 35% of participants showed changes in RVFWLS greater than 15%, whereas LVGLS changed by less than 15%. This indicates that RVFWLS is more sensitive to the treatment compared to LVGLS. Conclusions The study results indicate that during the initial phases of chemotherapy treatment in low cardiovascular risk patients, early changes in strain measures reveal subclinical cardiotoxicity. This suggests that GLS measurements are more effective at detecting early signs of myocardial damage and potential deterioration in cardiac function than traditional echocardiographic parameters. Additionally, it is noteworthy that RVFWLS exhibits greater sensitivity to these changes, regardless of the chemotherapy dosage and regimen.
目的 接受化疗的乳腺癌患者可能会出现癌症治疗相关的心血管毒性，尤其是那些已有心血管危险因素的患者。值得注意的是，右心室功能障碍可能在左心室之前出现。我们的研究旨在比较常规超声心动图与整体纵向应变（GLS）在接受低剂量蒽环类药物且心血管风险较低的患者中的应用，重点关注早期心脏毒性检测。此外，我们探讨右心室游离壁纵向应变（RVFWLS）在心脏毒性中的预测作用。方法 在最近一项研究中，对28名因乳腺癌接受低剂量蒽环类化疗且心血管风险较低的女性，使用二维超声心动图和斑点追踪超声心动图评估其心脏功能。测量指标包括左心室射血分数（LVEF）、右心室收缩功能（RVS'）、三尖瓣环平面收缩期位移（TAPSE）、左心室整体纵向应变（LVGLS）和RVFWLS。所有患者在研究开始时LVEF均正常。心脏毒性定义为LVEF新下降10%或低于53%和/或LVGLS/RVFWLS变化15%。结果 在我们的研究中，化疗后LVEF未观察到显著变化。LVEF值保持稳定，从63±3.7轻微变化至65.0±3.4，t检验值为1.790，p值为0.079。同样，分析发现化疗后RVS'和TAPSE值无显著变化。然而，应变测量中观察到显著变化。LVGLS从-21.2±2.1降至-18.6±2.6（t检验=-4.116；自由度=54，p=0.001），RVFWLS从-25.2±2.9降至-21.4±4.4（t检验=-3.82；自由度=54，p=0.001）。值得注意的是，35%的参与者RVFWLS变化大于15%，而LVGLS变化小于15%。这表明与LVGLS相比，RVFWLS对治疗更敏感。结论 研究结果表明，在心血管风险较低的患者化疗初始阶段，应变测量的早期变化揭示了亚临床心脏毒性。这表明GLS测量在检测心肌损伤早期迹象和心脏功能潜在恶化方面比传统超声心动图参数更有效。此外，值得注意的是，无论化疗剂量和方案如何，RVFWLS对这些变化表现出更高的敏感性。
