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154 Cardiac mri global longitudinal strain has greater sensitivity than ejection fraction to predict heart failure in breast cancer patients receiving trastuzumab
  1. Jian Yeo1,
  2. Ahmed Taha2,
  3. Mayada Mahjob2,
  4. Michael Sosin2
  1. 1University of Leicester, Glenfield Hospital, Leicester, LCE LE3 9QP, United Kingdom
  2. 2Nottingham University Hospitals NHS Trust


Introduction Myocardial strain assessment is recommended for patients undergoing echocardiographic surveillance while receiving potentially cardiotoxic chemotherapy but there is limited evidence on the utility of strain assessment on magnetic resonance imaging (MRI). We assessed the ability of left ventricular (LV) global longitudinal strain (GLS) on MRI to predict cancer therapy-related cardiac dysfunction (CTRCD).

Methods Thirty female breast cancer patients who underwent MRI (1.5T Philips Ingenia scanner) for monitoring of LV function while receiving Trastuzumab were retrospectively enrolled. Baseline LV volumes and GLS were obtained before commencing Trastuzumab and compared with follow-up scans at 3, 6, 9, and 12 months. CTRCD was determined using either the GLS criteria defined as >5% absolute reduction or >12% relative reduction of GLS or ejection fraction (EF) criteria defined as >10% absolute reduction to <50% or >20% absolute reduction, from baseline values. The primary outcome measure was clinically diagnosed heart failure within 1-year.

Results Mean age of participants was 64±10 years, 33% had hypertension and 7% had diabetes. Baseline GLS was 23 ± 3% and LVEF was 66 ± 6%. Mean LV end-diastolic and end-systolic volumes, but not stroke volume, were significantly increased during follow-up compared to baseline (Table 2). Both GLS (20.2 ± 3.1%, p<0.001) and EF (61.9 ± 5.7%, p<0.001) declined at 3 months compared to baseline and remained low until 12 months. Nine participants (30%) developed heart failure within a year. More CTRCD was diagnosed using GLS compared to EF criteria (67% vs 10%, p<0.001). Using these pre-specified cut-off values, the sensitivity and specificity to predict heart failure symptoms at 1-year were 78% and 35% for GLS, and 11% and 91% for EF, respectively.

Abstract 154 Table 1

Baseline characteristic of participants

Abstract 154 Table 2

Left ventricular volumes, global longitudinal strain, and ejection fraction measured at baseline and mean change during follow-up

Abstract 154 Figure 1

Left ventricular (LV) global longitudinal strain (GLS) measured at baseline and follow-up at 3, 6, 9, and 12 months.*=p<0.01 versus baseline

Abstract 154 Figure 2

Left ventricular ejection fraction (LVEF) measured at baseline and follow-up at 3, 6, 9, and 12 months.*p<0.01 versus baseline

Conclusion Both GLS and EF declined as early as 3 months after receiving Trastuzumab. GLS has greater sensitivity than EF to predict heart failure symptoms at 1-year. Incorporating assessment of GLS as part of cardiac MRI surveillance during chemotherapy may provide earlier detection of subclinical heart failure than using EF alone.

Conflict of Interest None

  • Trastuzumab
  • Cardiotoxicity
  • Myocardial strain

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