Submitted: 28 Sep 2016
Revision: 06 Feb 2017
Accepted: 07 Feb 2017
ePublished: 13 Mar 2017
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J Cardiovasc Thorac Res. 2017;9(1): 29-34.
doi: 10.15171/jcvtr.2017.04
PMID: 28451085
PMCID: PMC5402024
  Abstract View: 1079
  PDF Download: 720

Original Article

Two-dimensional strain echocardiography for detection of cardiotoxicity in breast cancer patients undergoing chemotherapy

Mehrnoush Toufan 1, Leili Pourafkari 1,2, Leyla Ghahremani Nasab 1, Ali Esfahani 3, Zohreh Sanaat 3, Alireza Nikanfar 3, Nader D Nader 2 *

1 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
3 Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran


Introduction: Two-dimensional (2D) strain echocardiography has emerged as a novel method for early diagnosis of myocardial dysfunction in patients receiving anthracycline chemotherapy. Certain myocardial segments might be more vulnerable for development of dysfunction.
Methods: Sixty-three patients with breast cancer who were deemed amenable for anthracycline chemotherapy were prospectively studied from March 2013 to March 2015 in University Hospital settings. Global left ventricular (LV) ejection fraction (EF), fractional shortening and the strain over 17 segments of the LV were examined using 2-dimensional transthoracic echocardiography (TTE) before and after chemotherapy. More than 15% reduction in longitudinal peak systolic strain (LPSS) was considered significant.
Results: The mean age of patients was 47 ± 10 years. LVEF was 59.7 ± 6.5% at baseline. Significant reduction of global LPSS was detected in 13% of patients. A significant LPSS reduction occurred in 32.4% of 1071 segments examined following chemotherapy. LPSS significantly decreased in 28% of apical segments, 31% of mid segments and 37% of basal segments. LPSS reduction occurred more frequently over the basal segments than all other segments (P = 0.031).
Conclusion: Segmental pattern appears to exist in LPSS reduction following anthracycline therapy. As significant segmental decreases can be seen in the setting of unchanged global LPSS, segmental evaluation of LPSS might be a more accurate way for assessment of myocardial function.
Keywords: Anthracycline, Breast Cancer, Strain Echocardiography
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