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. 2024 Apr 7;16(4):e57791.
doi: 10.7759/cureus.57791. eCollection 2024 Apr.

Comprehensive Assessment of Cardiac Function in Breast Cancer Patients: Integrating Multiparametric Speckle Tracking Imaging and Conventional Echocardiography Parameters

Marina Leitman  1   2 , Shmuel Fuchs  1   2 , Oran Tzuman  1   2 , Rotem Merose  2 , Sara Shimoni  3   4
Affiliations

Comprehensive Assessment of Cardiac Function in Breast Cancer Patients: Integrating Multiparametric Speckle Tracking Imaging and Conventional Echocardiography Parameters

Marina Leitman et al. Cureus. .

Abstract

Purpose The purpose of this study is to comprehensively evaluate the role of different echocardiography parameters in breast cancer patients undergoing chemotherapy. While echocardiography examination with calculation of ejection fraction (EF), is pivotal for patient monitoring, its operator dependence and insensitivity to subtle changes in left ventricular (LV) contractility present challenges. Global longitudinal strain (GLS), derived from speckle tracking, is more sensitive and stable than EF. Our research aimed to delineate supplementary echocardiography measurements beneficial for the cardiological monitoring of breast cancer patients. Methods Patients were followed up with echocardiography at baseline, during, and after the chemotherapy. Conventional echocardiography and multiple speckle tracking imaging parameters including myocardial work index, atrial strain, twist, and automatic EF were investigated. Results A total of 25 patients were recruited. A subset (15/25) exhibited pronounced GLS reduction, associated with decreased EF and altered cardiac mechanics. Patients with unchanged GLS were often hypertensive and on specific medications, in particular angiotensin-converting enzyme inhibitors (ACE inhibitors)/angiotensin II receptor blockers (ARBs), potentially indicating protective effects. Despite stability in other parameters, GLS and EF sensitivity highlight their importance. A strong correlation between manual and automated EF measurement methods was also observed. Conclusion Despite the small sample size, across diverse echocardiography parameters, GLS and EF are primarily affected by chemotherapy. Hypertensive individuals exhibited lower susceptibility to chemotherapy-induced damage, likely attributed to the cardioprotective properties of ACE inhibitors and angiotensin II receptor blockers. A strong correlation between automatic and Simpson-based EF was found.

Keywords: automatic ejection fraction; breast cancer patients; cardioprotection; cardiotoxicity; chemotherapy; global longitudinal strain; myocardial work index.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Correlation between two methods of EF calculation: automatic and Simpson method
X-axis: Simpson method-based calculation of ESVs end-systolic volume; EDVs: end-diastolic volume; EFs ejection fraction; Y-axis: automatic speckle tracking imaging-based calculation of ESVa end-systolic volume, EDVa end-diastolic volume, and EFa ejection fraction; ESV: blue color; EDV: green color; EF: pink color
See this image and copyright information in PMC

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