Early Detection of Anthracycline-Induced Cardiotoxicity in Female Breast Cancer Patients Using Speckle Tracking Echocardiography in an African Tertiary Institution.

Abstract

BACKGROUND: Although, survival rates have improved in breast cancer care, cardiotoxicity from chemotherapy used for breast cancer has emerged as an important cause of morbidity in these individuals. This study evaluated early myocardial dysfunction using two-dimensional (2D) speckle tracking echocardiography in breast cancer patients treated with anthracyclines. METHODOLOGY: Sixty-two patients with anthracycline naïve breast cancer and 62 controls were studied. All patients were treated with standard regimens containing epirubicin. Echocardiography was done at three time points (baseline, one month and three months). Left ventricular ejection fraction and global longitudinal strain were measured. RESULTS: The mean age of the subjects was 47.6±10.46 years, obesity was the most common co-morbidity (27.4%) followed by hypertension (14.5%). Over the three month-follow-up period, the left atrial volume increased from 21.4±6.90mls/m2 at baseline to 24.8±6.38mls/m2, the mean left ventricular ejection fraction decreased from 62.4±9.35% at baseline to 54.8±7.22%, and the average left ventricular global longitudinal strain decreased from -19.0±5.91% at baseline to -16.1±3.70% by three month-follow-up. The percentage change in GLS at one month was 15.98% compared to 4.06% change in ejection fraction at one month follow-up. Thirty-five patients (56.5%) developed cardiotoxicity; however, no significant predictor of cardiotoxicity was noted. CONCLUSION: This study showed reduced left ventricular ejection fraction, reduced left ventricular global longitudinal strain, and increased left atrial volume over a period of three months in breast cancer patients treated with anthracycline-based chemotherapy. It also confirms the usefulness of speckle tracking echocardiography in evaluating breast cancer patients pre-, intra-, and post-chemotherapy.