T Chitadze
In a 2-year study of postmenopausal breast cancer patients receiving anthracycline-containing regimens, GLS was the most sensitive and robust predictor of cardiotoxicity, outperforming EF. Early changes GLS predicted both early and late events, while diastolic indices showed temporal associations without independent predictive value; E/e' increased mainly in high-risk patients, NT-proBNP demonstrated diagnostic utility but was not independently predictive.
BACKGROUND: As breast cancer survival improves, cardiovascular toxicity has emerged as a major determinant of long-term outcomes. Cancer therapy-related cardiac dysfunction is particularly prevalent among postmenopausal women with increased cardiovascular risk, highlighting the need for early cardiotoxicity detection and targeted cardio-oncology surveillance.
OBJECTIVE: To assess correlations between longitudinal changes in Global longitudinal strain, conventional Left Ventricular systolic-diastolic echocardiographic parameters, and cardiac biomarkers for prediction and early detection of cancer therapy-related cardiac dysfunction.
METHODS: A prospective 24-month single-center study (December 2019-March 2024) assessed 74 postmenopausal patients with primary breast cancer receiving anthracycline or anthracycline-trastuzumab. Left ventricular systolic and diastolic function and N-terminal pro-B-type natriuretic peptide was measured at baseline and seven follow-up visits. Cardiotoxicity was defined by Ejection Fraction and Global Longitudinal Strain changes. Outcomes were analyzed using multiple regression, paired t-tests, ANOVA, and survival analyses (Kaplan-Meier, Cox), with cardioprotective therapy administered to high-risk patients and those with worsening left ventricular systolic parameters; p<0.05.
RESULTS: In 74 breast cancer patients receiving anthracycline-based therapy, CTRCD incidence increased from 13.5% to 36.5% over 24 months. GLS detected cardiotoxicity earlier and more frequently than EF. NT-proBNP >125 pg/mL was associated with early and moderate CTRCD, peaking at 3 months with high sensitivity (94.1%) and specificity (90.9%), whereas NT-proBNP >300 pg/mL identified a smaller subgroup with more severe biomarker elevation. Diastolic dysfunction progressed biphasically, with E/e' >15 observed exclusively in high-risk CTRCD patients. Overall, NT-proBNP thresholds provided robust short-term biomarkers for early and severe CTRCD surveillance. ROC analysis demonstrated good diagnostic performance of NT-proBNP for CTRCD detection (AUC=0.779; 95% CI 0.656-0.901; p<0.001). Among the evaluated thresholds, 125 pg/mL demonstrated the most balanced diagnostic performance, achieving 100% specificity and 48.3% sensitivity.
CONCLUSION: In a 2-year study of postmenopausal breast cancer patients receiving anthracycline-containing regimens, GLS was the most sensitive and robust predictor of cardiotoxicity, outperforming EF. Early changes GLS predicted both early and late events, while diastolic indices showed temporal associations without independent predictive value; E/e' increased mainly in high-risk patients, NT-proBNP demonstrated diagnostic utility but was not independently predictive.