Archives of the
Turkish Society of Cardiology
Original Article

Anthracycline Chemotherapy-Induced Electro-Mechanical Changes: Strain Echocardiography Combined with Repolarization Parameters on Electrocardiography to Predict Early Cardiotoxicity


Department of Cardiology, İstanbul Çam and Sakura State Hospital, İstanbul, Turkey


Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey


Department of Cardiology, Near East Faculty of Medicine, Nicosia, Turkish Republic of Northern Cyprus


Department of Medical Oncology, Ege University Faculty of Medicine, İzmir, Turkey

Archives of the Turkish Society of Cardiology 2022; 50: 478-484
DOI: 10.5543/tkda.2022.22359
Read: 411 Downloads: 119 Published: 30 September 2022

Objective: The aim of the study was to describe the acute cardiotoxic effects of anthracycline chemotherapy in echocardiographic strain and electrocardiographic repolarization parameters in patients with breast cancer.

Methods: A total of 35 consecutive patients (all females, mean age: 48.9 ± 11.8 years) who received chemotherapy due to breast cancer were prospectively included. Pre-treatment (T0) and third month (T2) 2-dimensional strain echocardiography and electrocardiography were performed. Additionally, within 3 hours of the first dose of chemotherapy (T1), additional electrocardiographic images were obtained. All mechanical and electrical parameters from different time intervals (T0, T1, and T2) were compared with each other.

Results: In the acute period after treatment, electrocardiographic repolarization parameters were prolonged and this prolongation continued to the third month (QT corrected with Bazett formula [440.10 ± 27.63 (T0), 468.00 ± 38.98 (T1), 467.86 ± 35.09 (T2)], QT dispersion [49.85 ± 19.52 (T0), 69.54 ± 16.06 (T1), 57.63 ± 14.42 (T2)], and T-wave peak-to-end interval [94.00 ± 45.46 (T0), 131.20 ± 17.79 (T1), 120.00 ± 18.32 (T2)]; P < .001). There was no significant change in global longitudinal strain values before and after treatment (global longitudinal strain avg: −21 ± 7.1%; P = .8). However, there were significant reductions in strain parameters including circumferential and radial strain, and torsion (−17.2 ± 3.5 to -13 ± 2.84; P < .001, 45.1 ± 8.3 to 35.6 ± 10; P <.001, and 12.1 ± 3.5 to 7.7 ± 2.1; P < .001, respectively).

Conclusion: Both the electrical and mechanical functions of the heart can be impaired acutely extending to 3 months after anthracycline chemotherapy. Therefore, cardiotoxicity should be evaluated early both electrically and mechanically after chemotherapy.

Cite this article as: Özbay B, Şimşek E, Kemal H, Çakar B, Yavuzgil O. Anthracycline chemotherapy-induced electro-mechanical changes: Strain echocardiography combined with repolarization parameters on electrocardiography to predict early cardiotoxicity. Turk Kardiyol Dern Ars. 2022;50(7):478-484.

ISSN 1016-5169 EISSN 1308-4488