Layer-Specific Strain Analysis for Early Detection of Anthracycline

Abstract

Background: Anthracycline-induced cardiotoxicity affects 6-18% of treated patients and can lead to irreversible heart failure. Left ventricular ejection fraction, the standard monitoring parameter, detects cardiac dysfunction only after substantial myocardial damage has occurred.

Aim: To review current evidence on layer-specific strain analysis for early detection of anthracycline-induced cardiotoxicity and to discuss its integration with cardiac magnetic resonance imaging.

Methods: We searched PubMed, Scopus, and Web of Science for articles published between January 2015 and December 2024 using predefined search terms related to anthracyclines, cardiotoxicity, and layer-specific strain. Original research articles, systematic reviews, and guidelines in English were included. Case reports and conference abstracts were excluded.

Results: Twenty-nine publications meeting inclusion criteria were analyzed. Studies consistently show that anthracycline-induced injury originates in the subendocardium and progresses transmurally. Layer-specific strain analysis detects subendocardial dysfunction when left ventricular ejection fraction and global longitudinal strain remain normal. The combination of echocardiographic strain with cardiac magnetic resonance T1/T2 mapping enables both functional and tissue-level assessment of early cardiotoxicity.

Conclusions: Layer-specific strain analysis can detect anthracycline-induced myocardial injury earlier than conventional parameters. Standardization of methodology and prospective validation studies are needed before routine clinical implementation.  

Keywords: Anthracycline; Cardiotoxicity; Layer-specific strain; Speckle tracking echocardiography; Cardiac magnetic resonance; Cardio-oncology