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 to be useful in identifying subclinical ventricular dysfunction. OBJECTIVES: a) To investigate the role of strain in the identification of subclinical ventricular dysfunction in patients who used DOX; b) to investigate determinants of strain response in these patients. METHODS: Cross-sectional study with 81 participants: 40 patients who used DOX ±2 years before the study and 41 controls. All participants had left ventricular ejection fraction (LVEF) ≥55%. Total dose of DOX was 396mg (242mg/ms(2)). 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 using ε(LL) (model 1) and ε(CC) (model 2) as dependent 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 with ε(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). On MLR, 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 in patients who used DOX ±2 years prior to the study despite normal LVEF, suggesting the presence of subclinical ventricular dysfunction; b) DOX was an independent predictor of reduced ε(CC); c) prior use of DOX and age were independent markers of reduced ε(LL).