Subclinical Ventricular Dysfunction Detected by Speckle Tracking Two Years after Use of Anthracycline

Background

Heart failure is a severe complication associated with doxorubicin (DOX) use.Strain, assessed by two-dimensional speckle tracking (2D-STE), has been shown tobe useful in identifying subclinical ventricular dysfunction.

Objectives

a) To investigate the role of strain in the identification of subclinicalventricular dysfunction in patients who used DOX; b) to investigate determinantsof strain response in these patients.

Methods

Cross-sectional study with 81 participants: 40 patients who used DOX ±2years before the study and 41 controls. All participants had left ventricularejection fraction (LVEF) ≥55%. Total dose of DOX was 396mg(242mg/ms²). The systolic function of the LV was evaluated by LVEF(Simpson), as well as by longitudinal (ε_LL), circumferential(ε_CC), and radial (ε_RR) strains.Multivariate linear regression (MLR) analysis was performed usingε_LL (model 1) and ε_CC (model 2) asdependent variables.

Results

Systolic and diastolic blood pressure values were higher in the control group (p< 0.05). ε_LL was lower in the DOX group (-12.4 ±2.6%)versus controls (-13.4 ± 1.7%; p = 0.044). The same occurred withε_CC: -12.1 ± 2.7% (DOX) versus -16.7 ± 3.6%(controls; p < 0.001). The S’ wave was shorter in the DOX group (p = 0.035). OnMLR, DOX was an independent predictor of reduced ε_CC (B =-4.429, p < 0.001). DOX (B = -1.289, p = 0.012) and age (B = -0.057, p = 0.029)were independent markers of reduced ε_LL.

Conclusion

a) ε_LL, ε_CC and the S’ wave are reduced inpatients who used DOX ±2 years prior to the study despite normal LVEF,suggesting the presence of subclinical ventricular dysfunction; b) DOX was anindependent predictor of reduced ε_CC; c) prior use of DOX andage were independent markers of reduced ε_LL.