02Mar 2018

ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN PATIENTS UNDERGOING CHEMOTHERAPY BY 2D STRAIN IMAGING.

  • Professor and HOD, Department of Cardiology, J. N. Medical College, Belgaum, Karnataka, India.
  • Professor, Department of Cardiology, J. N. Medical College, Belgaum, Karnataka, India.
  • Associate Professor, Department of Cardiology, J. N. Medical College, Belgaum, Karnataka, India
  • Senior Resident, Department of Cardiology, J. N. Medical College, Belgaum, Karnataka, India
  • Associate Professor, Department of Oncology, J. N. Medical College, Belgaum, Karnataka, India.
  • Msc Post Graduate, Department of Cardiology J. N. Medical College, Belgaum, Karnataka, India.
  • Assistant Professor, Department of Cardiology, J. N. Medical College, Belgaum, Karnataka, India.
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Introduction: Chemotherapy is one of the largest areas of pharmaceutical development. However, the nature of chemotherapy means that while damaging the cancer cells it also damages healthy cells and myocardium is no exception. Cancer patients usually receive a cocktail of chemotherapy drugs, which can result in myocardial injury and left ventricular dysfunction. Echocardiography is the gold standard for assessment of heart function in these patients before, during and after the treatment. In addition Systolic myocardial strain imaging can theoretically detect cardio toxicity early. Objective: Assessment of left ventricular function in patients undergoing chemotherapy by 2D Strain imaging Material & methods: 74 consecutive patients who were subjected for chemotherapy with an age above 18 years were considered for the study. Subjects who had prior structural or functional heart disease, previous history of ischemic heart disease, who underwent percutaneous transluminal angioplasty and/or prior coronary artery bypass grafting, received radiotherapy, LV dysfunction at baseline and with baseline LBBB were excluded from the study. Patients who met the inclusion criteria were subjected for ECHO assessment at baseline and for the second time after completion of the chemotherapy regimen. Data was analyzed by using SPSS software. Results: Out of 74, 49 were females and 25 were males. 8 (10.8%) out of 74 developed reduction of LVEF > 15% at the end of the chemotherapy regimen. In the 2D strain parameters, mean Global longitudinal strain was significantly reduced in post chemotherapy (-19.33?1.75) individuals when compared to mean pre chemotherapy global longitudinal strain (-23.15?2.4) especially in patients who had more than 15% (n=8) drop in their EF. Global Circumferential Strain reduction was not found to be consistent with reduction of LVEF. Conclusion: Strain imaging, Global Longitudinal Strain in particular is ideal for screening and risk profiling of patients undergoing chemotherapy and should be recommended in all patients.


  1. Siegel, R. L., Miller, K. D. and Jemal, A. (2017), Cancer statistics, 2017. CA: A Cancer Journal for Clinicians, 67: 7?30. doi:10.3322/caac.21387
  2. Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D. M., Forman, D. and Bray, F. (2015), Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer, 136: E359?E386. doi:10.1002/ijc.29210
  3. International Agency for Research on Cancer. World Cancer Fact Sheet. Geneva, Switzerland: World Health Organization; 2012. Available at:, http://gicr.iarc.fr/files/resources/20120906-WorldCancerFactSheet.
  4. Minami M, Matsumoto S, Horiuchi H. Cardiovascular side-e ects of modern cancer therapy. Circ J 2010;74:1779-86.
  5. Hooning MJ, Botma A, Aleman BM, et al. Long-term risk of car- diovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 2007;99:365?75.
  6. Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopa- thy. N Engl J Med 2000;342:1077?84.
  7. ,TasakaH.,YuK.P.,MurphyM.L.,KarnofskyD.A.Daunomycin,anantitumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with special ref- erence to childhood leukemia, Cancer 20 (1967) 333 ? 353.
  8. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016; 211
  9. Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R. Strain and strain rate imaging by echocardiography: basic concepts and clinical applicability.CurrCardiolRev2009; 5:133-48
  10. Shaw SM, Fox DJ, Williams SG. The development of left ventricular torsion and its clinical relevance. IntJCardiol2008; 130:319-25.
  11. Teske AJ, DeBoeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJ. Echocardiography quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking. Cardiovasc Ultrasound 2007; 5:27
  12. Heimdal A, Stoylen A, Torp H, Skjaerpe T. Real-time strain rate imaging of the left ventricle by ultrasound. J Am Soc Echocardiogr 1998; 11:1013-9
  13. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain Imaging by echocardiography: from technical considerations to clinical applications. JAmSoc Echocardiogr2007; 20:234-43
  14. Brown J, Jenkins C, Marwick T. Use of myocardial strain to assess global left ventricular function : a comparison with cardiac magnetic resonance and 3-dimensional echocardiography. Am Heart J 2009; 157:102e1-5
  15. Yoon HJ, Kim KH, Kim JY, Park HJ, Cho JY, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG, Park JC.???Chemotherapy-Induced Left Ventricular Dysfunction in Patients with Breast Cancer.?? J Breast Cancer. 2016 Dec;19(4):402-409.
  16. Hershman DL, Shao T. Anthracycline cardiotoxicity a er breast cancer treatment. Oncology (Williston Park) 2009;23:227-34.

[Suresh V Patted, Sanjay C Porwal, Sameer S Ambar, M R Prasad, Nikhil B, Rohan Bhise, Sateesh Savadatti6, Vishwanath Hesarur, Vaibhav Patil and Suhasini A. (2018); ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN PATIENTS UNDERGOING CHEMOTHERAPY BY 2D STRAIN IMAGING. Int. J. of Adv. Res. 6 (Mar). 79-86] (ISSN 2320-5407). www.journalijar.com


Dr. Nikhil. B
JN Medical College, KLE University, Belagavi, India

DOI:


Article DOI: 10.21474/IJAR01/6652      
DOI URL: http://dx.doi.org/10.21474/IJAR01/6652