Evaluation of cardiotoxicity induced by different regimens of cancer therapy in women with breast cancer

Abstract

In recent years, a significant success has been achieved in the treatment of breast cancer with the development of new effective therapeutic regimens in addition to traditional therapies. Along with the mentioned positive trends an increasingly urgent problem, cancer-therapy related side effects have emerged. The most important is the cardiac dysfunction or cardiotoxicity which essentially worsens the prognosis and ranks the first among the fatal complications caused by cancer therapy. All of the above has become a determinant of the actualization of the issue of early diagnosis and management of cardiotoxicity.  According to the guidelines, the left ventricular ejection fraction is considered the main measurement for predicting and detecting cardiotoxicity, however, the decrease in LVEF mainly occurs in the late stages, when a large myocardium area is damaged. Our review analysis suggests that the global longitudinal strain is a more sensitive and accurate marker for detecting early, subclinical, subtle left ventricular dysfunction and heart failure than standard echocardiographic parameters (left ventricular ejection fraction). The drop in global longitudinal strain is informative in asymptomatic patients even with preserved ejection fraction, predicts reduction of ejection fraction and subsequent cardiotoxicity, with diagnostic and predictive ability superior to EF and other strain parameters. Speckle tracking echocardiography is an advanced imaging technique designed for better feasibility than standard echo to detect subclinical cardiotoxicity in breast cancer patients. The three-dimensional echocardiography is potentially superior to the two-dimensional echocardiography in early detection of cardiac dysfunction. Biomarkers may be useful for predicting cardiotoxicity. Administration and monitoring of cardioprotective therapy via global longitudinal strain should potentially improve cardiac function in patients at risk of cancer-related cardiotoxicity. Early detection of cardiotoxicity can help modify cancer therapy prevent irreversible heart damage