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Applications of left ventricular strain measurements to patients undergoing chemotherapy

Clasen, Suparna C.; Scherrer-Crosbie, Marielle

doi: 10.1097/HCO.0000000000000541

Purpose of review We aim to summarize the utility of strain in monitoring the effects of cancer therapy-related cardiotoxicity (CTRC) on the development of left ventricular (LV) dysfunction.

Recent findings Serial assessment of cardiac function at baseline and during treatment is recommended in patients undergoing cancer treatment. Historically, the use of left ventricular ejection fraction (LVEF) has been used to monitor for cardiac toxicity from cancer therapies but myocardial mechanic parameters, in particular global longitudinal strain (GLS), have emerged as powerful adjunctive tools. On the basis of longitudinal cohort studies in patients treated with anthracyclines and trastuzumab and retrospective studies of childhood survivors of cancers, strain has been used to detect subclinical LV dysfunction prior to changes in LVEF. Strain parameters decrease during both anthracycline and trastuzumab and these changes can persist after completion of therapy. Baseline GLS and changes in GLS during therapy can be independently prognostic for developing CTRC. Further, GLS has appeared to have an additive predictive value in addition to the traditional clinical parameters and baseline LVEF in the development of cardiotoxicity. The inclusion of strain parameters in clinical decision making and therapeutic planning is an area of intense research.

Summary This review seeks to highlight the importance of echocardiographic strain measurements in early detection, treatment and prevention of LV dysfunction from CTRC.

Cardio-oncology Program and Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Marielle Scherrer-Crosbie, MD, PhD, Cardiovascular Medicine Division, Perelman Center for Advanced Medicine, 11th Floor - South Tower, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA. Tel: +1 215 662 3569; e-mail:

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