Assessment of cancer therapy-related cardiac dysfunction in breast cancer women using a new speckle tracking echocardiography index: The GAVS

Background: Recently, peak atrial longitudinal strain (PALS) has emerged as a possiblepredictor of Cancer therapy-related cardiac dysfunction (CTRCD) in cancer patients(CP), in addition to left ventricular global longitudinal strain (GLS). Thus, consideringthe link between left atrium and left ventricle, the aim of this study was to assess theglobal atrio-ventricular strain (GAVS) in CP, to detect early cardiotoxicity.Methods: A prospective study was carried out enrolling 131 breast cancer women(mean age 51.4 ± 10.4 years) receiving anti-cancer treatment. Clinical and echocar-diographic evaluation was performed at baseline (T0), 3 (T1), 6 (T2) and 12 months(T3) after starting treatment. CTRCD was defined according to the 2022 ESCCardio-Oncology guidelines.Results: Forty-four patients developed CTRCD (3 moderate and 41 mild CTRCD groupA) and 87 patients did not (group B). In group A, significant changes in GLS, PALS, GAVS,LASi (left atrial stiffness index) and LVEF/GLS occurred earlier than LVEF, that reducedsignificantly only at T3 (p-value < .05). Significant changes in LASi, PALS and GAVSoccurred even in group B but reduction in GAVS (−21% vs. −5%) and PALS (−24% vs.−12%) was significantly greater in group A compared to group B (p-value = .04).Conclusions: Our study confirms high sensitivity of speckle tracking echocardiographyin detecting subclinical myocardial damage in CP and the usefulness of a multiparamet-ric echocardiographic evaluation including PALS and GLS (GAVS) for having a globalevaluation of the phenomenon cardiotoxicity.