The development of tools for the early identification of patients at greater risk of cancer therapy-related cardiac dysfunction and heart failure is an area of active research in cardio-oncology. It has been recently showed that the traditional definition of cancer therapy-related cardiac dysfunction as a reduction in left ventricular ejection fraction with traditional echocardiography might not be sensitive enough to detect myocardial damage when it can be still reverted.
Aim: To detect early changes of new echocardiographic measures in patients treated with epirubicin; to investigate whether there is a relationship between these new echocardiographic measures and biomarkers associated with the development of cardiotoxicity. Their prognostic value as early markers for the development of cancer therapy-related cardiac dysfunction will be assessed.
Methods: Breast cancer patients free from previous cardiovascular disease and exposed to epirubicin will be recruited. Patients will receive both conventional and layer-specific myocardial 2D strain echocardiography at baseline, at the completion of chemotherapy as well as 3, 6 months and 1 year after the end of chemotherapy. Peak systolic dispersion will be also assessed. Biomarkers (high-sensitivity troponin, Nt-pro-BNP and BNP) will be assessed before every cycle of the regimen, at the completion of chemotherapy as well as 3, 6 months and 1 year after the end of chemotherapy.
Expected results: Changes in regional Layer-specific Myocardial Strain will develop by the completion of the regimen, and they will be significantly associated with later development of left ventricular dysfunction during the 1 year follow up. Such early modification in layer-specific regional strain will be associated with an early increase of biomarkers. If so, the integration of these new tools in clinical practice might facilitate the use of targeted cardioprotective strategies to prevent the subsequent development of heart failure.
