Global Longitudinal Strain in Cardio-Oncology: A Review

SIMPLE SUMMARY: The assessment of global longitudinal strain (GLS) has an established role in cardio-oncology in the early diagnosis of the cardiotoxicity of anticancer treatments. Baseline left ventricular (LV) GLS and right ventricular (RV) GLS assessments can identify patients at risk for systolic dysfunction and heart failure due to the cardiotoxicity of various cancer treatments. Depending on the baseline risk of cardiotoxicity assessed before treatment initiation, serial echocardiography with a GLS assessment should be performed during the anticancer therapy to enable prompt initiation and dose adjustment for cardioprotection in the event of subclinical myocardial contractile dysfunction. We recommend routine GLS assessments in cardio-oncology patients if the patient’s imaging conditions allow it. ABSTRACT: Several therapies used in cancer treatment are potentially cardiotoxic and may cause left ventricular (LV) dysfunction and heart failure. For decades, echocardiography has been the main modality for cardiac assessment in cancer patients, and the parameter examined in the context of cardiotoxicity was the left ventricular ejection fraction (LVEF). The assessment of the global longitudinal strain (GLS) using speckle tracking echocardiography (STE) is an emerging method for detecting and quantifying subtle disturbances in the global long-axis LV systolic function. In the latest ESC guidelines on cardio-oncology, GLS is an important element in diagnosing the cardiotoxicity of oncological therapy. A relative decrease in GLS of >15% during cancer treatment is the recommended cut-off point for suspecting subclinical cardiac dysfunction. An early diagnosis of asymptomatic cardiotoxicity allows the initiation of a cardioprotective treatment and reduces the risk of interruptions or changes in the oncological treatment in the event of LVEF deterioration, which may affect survival.