From the Guidelines
Global Longitudinal Strain (GLS) echocardiography is a crucial tool for monitoring cancer patients receiving potentially cardiotoxic agents, as it can detect subclinical cardiac damage before changes in ejection fraction become apparent. The role of GLS echo in monitoring cancer patients is to provide an early detection of cardiac dysfunction, allowing for timely intervention to prevent progression to clinical heart failure. According to the study by S. Bringhen et al. 1, GLS assessed using automated speckle tracking echocardiography is an emerging technique for detecting and quantifying subtle disturbances in LV systolic function.
Key Points for GLS Monitoring
- GLS should be measured at baseline before treatment begins and then monitored regularly during and after therapy
- A relative reduction in GLS of >15% from baseline is considered significant and may indicate early cardiotoxicity, even when ejection fraction remains normal 1
- GLS monitoring is particularly important for patients receiving cardiotoxic treatments, with assessments recommended regularly during treatment and periodically afterward based on risk factors
- GLS is more sensitive than conventional echocardiographic parameters because it measures the heart's deformation rather than just volumetric changes, allowing detection of subtle myocardial dysfunction
Clinical Application
When GLS deterioration is detected, clinicians should consider cardioprotective strategies such as ACE inhibitors or beta-blockers, and potential modification of cancer therapy in consultation with oncology 1. This approach enables early intervention that may prevent progression to clinical heart failure while allowing continuation of life-saving cancer treatments. The European Myeloma Network and the Italian Society of Arterial Hypertension also recommend the use of GLS for monitoring cardiotoxicity in myeloma patients receiving carfilzomib 1.
Comparison with Other Imaging Modalities
While cardiac magnetic resonance is the reference standard in assessing LV and right ventricle volumes and function, GLS echocardiography is a valuable alternative for monitoring cancer patients receiving cardiotoxic treatments, especially when cardiac magnetic resonance is not available 1. Multigated angiography can also provide a highly reproducible quantification of LVEF, but radiation exposure remains its main limitation 1.
From the FDA Drug Label
Cardiac Monitoring Conduct thorough cardiac assessment, including history, physical examination, and determination of LVEF by echocardiogram or MUGA scan
The role of Global Longitudinal Strain (GLS) echo in monitoring cancer patients receiving potentially cardiotoxic agents is not directly mentioned in the provided drug label.
- The label recommends cardiac monitoring using LVEF measurement by echocardiogram or MUGA scan.
- It does not provide information on the use of GLS echo in this context 2.
From the Research
Role of Global Longitudinal Strain (GLS) Echo in Monitoring Cancer Patients
- GLS echo is a vital tool in the early detection of cardiotoxicity in patients receiving potentially cardiotoxic agents, such as anthracyclines 3, 4, 5.
- Peak systolic global longitudinal strain (GLS) by speckle-tracking echocardiography has emerged as a reliable measure to identify early subclinical left ventricular (LV) dysfunction in patients on cardiotoxic chemotherapy 3.
- A reduction in LV global longitudinal strain (GLS) of >15% relative reduction from baseline has been widely used to detect cardiotoxicity 3.
- GLS can predict early subclinical LV dysfunction, and initiation of cardioprotective therapy led to less decline of LV function 3, 6.
Comparison of 2D and 3D Echocardiography
- 2D echocardiography can detect significant reductions in GLS, while 3D echocardiography can provide more accurate assessments of LV function and detect smaller changes in GLS 4.
- 3D echocardiographic assessment seems to be more accurate in picking out small changes in left ventricular functions, but at the cost of slightly poor image quality as compared to the 2D echocardiography 4.
Clinical Implications
- GLS-guided cardioprotective therapy may provide less cardiac dysfunction in survivors of potentially cardiotoxic chemotherapy, compared with usual care 6.
- Echocardiography, preferably three-dimensional and strain imaging, is recommended to monitor for cardiotoxic myocardial effects before, during, and after chemotherapy with cardiotoxic drug regimens 7.
- Lifelong surveillance using echocardiography for cardiotoxicity and radiation-related valvular, pericardial, and coronary artery disease is prudent 7.