Background: Anthracyclines, a widely used chemotherapy agent with a definite survival
improvement, can result in cardiac toxicity presenting with HF (heart failure).
Objective: We aim to assess the predictive value of cardiac biomarkers assessment in combination
with myocardial two-dimensional strain echocardiography for early detection of cardiac toxicity in
patients who underwent Anthracycline-based chemotherapy.
Methods: Fifty-two consecutive adult patients scheduled to undergo the first course of
Anthracycline-based chemotherapy were subjected to the study. All the patients underwent highly
sensitive 2D echocardiographic evaluation before the treatment, 4 and 12 weeks after completion of
first-course chemotherapy. Longitudinal and segmental strains were measured. Serum levels of
High-sensitive cardiac troponin I (hscTn-I) and N-terminal-pro-BNP (NT-proBNP) were also
assessed before the initiation and 3 weeks after completion of first-course chemotherapy.
Results: Fifteen patients (28.8%) revealed a decrease in LVEF (Left Ventricular Ejection Fraction)
throughout the evaluations, while just 5 patients met the criteria of cardiac toxicity (9.6%). AUC for
Global Longitudinal Strain (GLS) ROC curve at 4 weeks of follow-up was calculated to be 0.968.
Inferoseptal Systolic Longitudinal Strain (SLS) had the highest AUC value (AUC: 0.934) among
different wall SLS. LVESD (Left Ventricular End-Systolic Diameter) at first and second evaluation
could predict the risk of cardiac toxicity among LVESD, LVEDD (Left Ventricular End Diastolic
Diameter) and LVEDV (Left Ventricular End-Diastolic Volume). Among cardiac biomarkers, hscTnI
had higher sensitivity, while NT-proBNP had higher specificity for cardiac toxicity.
Conclusion: This study has shown that hs-cTnI with good sensitivity can predict cardiac toxicity in
Anthracycline-based chemotherapy receiver. The use of strain with speckle echocardiography
method has a prognostic value; however, both longitudinal and segmental strain should be assessed.
Lateral and inferoseptal SLS (Segmental Longitudinal Strain) are specific markers of cardiac
toxicity in the course of anthracycline-related cardiac toxicity.