The role of echocardiography in detection of chemotherapy-induced cardiotoxicity in breast cancer patients

Context: The incidence of breast malignancy is increasing and it became evident that chemotherapy protocols that are based on anthracyclinesandtrastuzumab, which are being used in these patients, have cardiotoxic effect. Traditional imagingmethods could detect the advance stage of chemotherapy-induced cardiomyopathy when cardiac function is significantly impaired. New imaging tools, primarily speckle tracking analysis, could improve detection of cardiotoxicity. Evidence Acquisition:We searched PubMed, Medline, OVID and EMBASE databases for the studies published from January, 1990 up to May, 2016 in the English language using the following keywords: “chemotherapy”, “cardiac toxicity”, “left ventricle”, “anthracyclines”, and “trastuzumab”. Results: Studies show that early signs of chemotherapy-mediated cardiotoxicity in breast cancer patients could be identified even one week after the introduction of anthracycline treatment. Investigations also reported deterioration of the left ventricular mechanics 3, 6 and 12 months after chemotherapy. This suggests that left ventricular strain should be used as an important marker of the left ventricular dysfunction, which might be used simultaneously for detection of cardiotoxicity and for the monitoring of potential improvement of left ventricular function after chemotherapy interruption. Conclusions: New imaging tools provide insight in cardiac function and mechanics, much better than traditional methods. The ability of mechanical changes to predict subsequent cardiotoxicity needs to be evaluated in larger multicenter and longitudinal studies.