Echocardiography pearl: using strain imaging in cardiac oncology

You can apply strain imaging echocardiography to assess if your cancer patient is suffering from cardiotoxicity induced by chemotherapeutic agents. If the global longitudinal strain (GLS) values increase above a certain level, it’s high time you let the oncologist in charge know.

The evaluation of myocardial function can be tricky. This course will help you master an easy-to-follow process on how to acquire, optimize, and interpret left ventricular strain images. Using hands-on tips and tricks, you’ll cover global longitudinal strain (GLS) as well as important pearls and pitfalls as we go through several exciting real-life examples. Get ready to become an echo expert!

Echocardiographic imaging is important for the management of cardiac oncology patients during treatment. Left Ventricular ejection fraction, or LVEF is the most widely used parameter for identifying left ventricular dysfunction in these patients, but it is not sensitive enough to detect subtle changes in cardiac function caused by cardiotoxic agents. In contrast, changes in GLS values have been shown to be an early marker of cardiac toxicity. Specifically, a 10 to 15% change from baseline values indicate some level of alteration in tissue deformation, and predicts the development of subsequent decreases in left ventricular function.

So it is highly recommended to use strain imaging for the evaluation of adult patients before, during and after cancer therapy. Let's go through an example of how to use strain imaging to assess a patient for cardiac toxicity. To do this, you need to calculate the overall change in GLS value between the baseline and follow up. Take the baseline value, which is negative 22.1% minus the follow up GLS value of negative 16.4% divided by the baseline value. So here, the overall change in GLS is 25.8%, which is more than 15%. This means that the chemotherapy is affecting the myocardium and you should let the oncologist know so they can consider adjusting the drug dosage or pause therapy until the myocardial function improves. Guidelines recommend that cancer patients are followed up with echocardiographic imaging every three to six months based on their risk, signs or symptoms of cardiac dysfunction.