Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 6;13(11):3352.
doi: 10.3390/jcm13113352.

Left Ventricular Twist and the "Rigid Body Rotation" Pattern in Patients Treated with Anthracyclines or Anti-HER2

Federico Guerra  1   2 , Giulia Stronati  2 , Alice Frangione  1 , Edlira Rrapaj  1 , Marco Flori  3 , Michele Alfieri  2 , Samuele Principi  1 , Alessandro Barbarossa  1 , Giuseppe Ciliberti  1 , Antonio Dello Russo  1   2
Affiliations

Left Ventricular Twist and the "Rigid Body Rotation" Pattern in Patients Treated with Anthracyclines or Anti-HER2

Federico Guerra et al. J Clin Med. .

Abstract

Background: During the physiological cardiac cycle, the helix orientation of the muscle fibres induces the rotation of the apex relative to the base of the left ventricular (LV). In heart failure, LV torsion is impaired, and rotation at basal and apical levels occurs in the same direction, a phenomenon called rigid body rotation (RBR). We aimed to evaluate whether the RBR pattern and GLS together could improve the diagnosis of cardiotoxicity in patients treated with anthracyclines and/or anti-HER2. Methods: With an observational, retrospective study involving 175 patients (mean age 55 ± 12 years, 94% females), we evaluated the development of cancer therapeutic-related cardiac dysfunction (CTRCD) defined according to ESC guidelines. We characterised LV dysfunction by echocardiographic standard and speckle-tracking (GLS and RBR pattern) measurements. Patients with a previous diagnosis of structural heart disease or atrial fibrillation were excluded. Results: At the time of enrolment, the chemotherapy regimen included trastuzumab (96%), pertuzumab (21%), and anthracyclines (13%). Twenty-two patients (12.5%) developed cardiotoxicity, and thirteen patients developed an RBR within 6 months of follow-up. In all cases, the RBR pattern was associated with cardiotoxicity (p < 0.001), reporting an optimal specificity but poor sensitivity at three and six months. However, the addition of the RBR pattern to the global longitudinal strain (GLS) ≥ -16% increased the odds ratio (OR) from 25.6 to 32.6 at three months and from 32.5 to 49.6 at six months rather than GLS alone. Conclusions: The RBR pattern improves the diagnostic accuracy of GLS for the detection of cardiotoxicity secondary to anthracyclines and anti-HER2-based treatments.

Keywords: anthracycline; cardiotoxicity; chemotherapy; heart failure; speckle tracking; twist.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
LV torsion speckle-tracking analysis: (a) a normal pattern with a clockwise rotation of the LV at the basal level (purple line) and a counterclockwise rotation of the apex (light blue line); (b) an RBR pattern due to reversed (clockwise) apical rotation; (c) an RBR pattern due to reversed (counterclockwise) basal rotation. The purple line (base) and the blue line (apex) represent the degree of rotation in a clockwise (below the zero line) or in a counterclockwise (above the zero line) direction. The white line represents the total twist generated by the left ventricle as the difference between the apical and basal rotations.
Figure 2
Figure 2
LV ejection fraction (a) and GLS (b) over the follow-up, according to the development of CTRCD.
See this image and copyright information in PMC

References

    1. Curigliano G., Lenihan D., Fradley M., Ganatra S., Barac A., Blaes A., Herrmann J., Porter C., Lyon A.R., Lancellotti P., et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann. Oncol. 2020;31:171–190. doi: 10.1016/j.annonc.2019.10.023. - DOI - PMC - PubMed
    1. ESC Scientific Document Group 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC) Eur. Heart J. 2022;43:4229–4361. doi: 10.1093/eurheartj/ehac244. - DOI - PubMed
    1. Truong J., Yan A.T., Cramarossa G., Chan K.K.W. Chemotherapy-Induced Cardiotoxicity: Detection, Prevention, and Management. Can. J. Cardiol. 2014;30:869–878. doi: 10.1016/j.cjca.2014.04.029. - DOI - PubMed
    1. Bloom M.W., Hamo C.E., Cardinale D., Ky B., Nohria A., Baer L., Skopicki H., Lenihan D.J., Gheorghiade M., Lyon A.R., et al. Cancer Therapy–Related Cardiac Dysfunction and Heart Failure. Circ. Heart Fail. 2016;9:e002843. doi: 10.1161/CIRCHEARTFAILURE.115.002843. - DOI - PMC - PubMed
    1. Khouri M.G., Douglas P.S., Mackey J.R., Martin M., Scott J.M., Scherrer-Crosbie M., Jones L.W. Cancer Therapy–Induced Cardiac Toxicity in Early Breast Cancer. Circulation. 2012;126:2749–2763. doi: 10.1161/CIRCULATIONAHA.112.100560. - DOI - PMC - PubMed