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3D-derived speckle tracking for the assessment of myocardial deformation in breast cancer patients submitted to anthracycline chemotherapy
Session:
Posters 4 - Écran 04 - Insuficiência Cardíaca
Speaker:
Madalena Coutinho Cruz
Congress:
CPC 2018
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Posters
FP Number:
---
Authors:
Madalena Coutinho Cruz; Guilherme Portugal; Luisa Moura Branco; Ana Galrinho; Ana Teresa Timóteo; Joana Gomes Feliciano; Pedro Rio; Fernanda Varela Gameiro; Sónia Duarte Oliveira; Ricardo da Luz; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) and 2D left ventricular global longitudinal strain (GLS) is the gold standard in screening for cancer therapeutics-related cardiac dysfunction (CTRCD). Myocardial deformation assessed with 3D speckle tracking is not currently used in this setting, despite of a potential for a greater reliability, because of the lack of published data.</p> <p><strong>Methods:</strong> This was a prospective study of female breast cancer patients submitted to chemotherapy with anthracyclines with or without adjuvant immunotherapy and/or radiotherapy who underwent serial monitoring by 2D and 3D transthoracic echocardiography. Standard echocardiographic measures and 3D-derived volumetric measures were assessed. Speckle tracking was used to estimate 2D and 3D-derived GLS, and 3D-derived global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS). CTRCD was defined as an absolute decrease in 2D LVEF > 10% to a value < 54% or a relative decrease in 2D GLS > 15%. Variables were compared using the t-student paired test and the Wilcoxon sign-rank test, when appropriate. Receiver operating curve analysis was used to assess the discrimination of 3D-derived deformation parameters for predicting CTRCD. An area under the curve (AUC) > 0.65 was considered a good discrimination.</p> <p><strong>Results:</strong> 91 patients (mean age 54.6 ± 12.9 years, 33.0% immunotherapy, 16.5% radiotherapy, baseline LVEF 63.4% ± 9.3%, baseline 2D GLS -20.7 ± 3.0) were included. During a mean follow-up of 16.5 ± 9.6 months, 13 patients (14.3%) developed CTRCD. When comparing variables before and during treatment, there was a significant difference in 2D-derived LVEF (63.4 vs. 56.6 p < 0.001), 3D-derived LVEF (62.1 vs. 56.9 p 0.028), 2D-derived GLS (-20.7 vs. -18.5 p < 0.001), 3D-derived GLS (-13.8 vs. -12.9 p 0.035), 3D-derived GRS (37.3 vs. 35.2 p 0.024), but not in GCS (-14.5 vs. -13.2 p 0.110) and GAS (-21.8 vs. -23.1 p 0.514). The AUC for 3D GLS was 0.656, -9.54 being the value with better discrimination for CTRCD (likelihood ratio 1.50). The AUC for GRS was 0.696, 36.5 being the value with better discrimination for CTRCD (likelihood ratio 1.49).</p> <p><strong>Conclusion: </strong>In this population, there was worsening of 3D GLS and GRS, besides conventional values, such as LVEF and 2D GLS, during anthracycline-based cancer treatment. 3D-derived myocardial deformation parameters show promise in the setting of CTRCD, since both 3D GLS and GRS have good discrimination for CTRCD.</p>
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