Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 4, August 2021, pages 238-243

Global and Regional Longitudinal Strain Reduction in Breast Cancer Patients After First Chemotherapy Cycle With Fluorouracil, Adriamycin, and Cyclophosphamide Regimen

Figure 2. Worsening of RLS during chemotherapy with anthracyclines regiment. The segments shown in dark blue represented significant worsening of RLS by the t-test. RLS: regional longitudinal strain.

Figure 3. The Bland-Altman analysis showing that the difference in GLS value was less than 10% in our center. GLS: global longitudinal strain.

**Table 1.** Baseline Characteristics
Baseline characteristics	n = 36
SD: standard deviation; BMI: body mass index; BSA: body surface area; CVD: cardiovascular disease.
Age (years), mean ± SD	46 ± 9
Weight (kg), mean ± SD	56 ± 8
Height (m), mean ± SD	1.54 ± 0.06
BMI (kg/m²), mean ± SD	23.66 ± 3.04
BSA, mean ± SD	1.53 ± 0.12
Cancer type, n (%)
Invasive ductal carcinoma mammae	34 (94)
Invasive carcinoma of no specific type	1 (3)
Clear cell carcinoma mammae	1 (3)
Adjuvant, n (%)	29 (80.6)
Neo-adjuvant, n (%)	7 (19.4)
Cardiovascular risk factors, n (%)
Obesity	12 (33.3)
Hypertensive heart disease	3 (8.3)
Hypertension	3 (8.3)
Diabetes mellitus	0 (0.0)
History of anthracycline chemotherapy	0 (0.0)
History of radiotherapy	0 (0.0)
Family history of premature CVD	0 (0.0)
Smoking	1 (2.8)

Table 1. Baseline Characteristics

Baseline characteristics

n = 36

SD: standard deviation; BMI: body mass index; BSA: body surface area; CVD: cardiovascular disease.

Age (years), mean ± SD

46 ± 9

Weight (kg), mean ± SD

56 ± 8

Height (m), mean ± SD

1.54 ± 0.06

BMI (kg/m²), mean ± SD

23.66 ± 3.04

BSA, mean ± SD

1.53 ± 0.12

Cancer type, n (%)

Invasive ductal carcinoma mammae

34 (94)

Invasive carcinoma of no specific type

1 (3)

Clear cell carcinoma mammae

1 (3)

Adjuvant, n (%)

29 (80.6)

Neo-adjuvant, n (%)

7 (19.4)

Cardiovascular risk factors, n (%)

Obesity

12 (33.3)

Hypertensive heart disease

3 (8.3)

Hypertension

3 (8.3)

Diabetes mellitus

0 (0.0)

History of anthracycline chemotherapy

0 (0.0)

History of radiotherapy

0 (0.0)

Family history of premature CVD

0 (0.0)

Smoking

1 (2.8)

**Table 2.** Comparative Study of GLS and LVEF at Baseline and 3 Weeks After the First Chemotherapy Cycle Using T-Test
Characteristic	Baseline, mean ± SD (%)	3 weeks, mean ± SD (%)	Difference, mean (95% CI) (%)	P value
*The GLS was reduced significantly after 3 weeks. CI: confidence interval; GLS: global longitudinal strain; LVEF: left ventricular ejection fraction; SD: standard deviation.
GLS	-20.7 ± 2.4	-19.1 ± 2.8	-1.6 (-2.6 to -0.7)	0.002*
LVEF biplane	67.8 ± 4.5	65.8 ± 5.1	2.0 (-0.2 to 4.3)	0.067

Table 2. Comparative Study of GLS and LVEF at Baseline and 3 Weeks After the First Chemotherapy Cycle Using T-Test

Characteristic

Baseline, mean ± SD (%)

3 weeks, mean ± SD (%)

Difference, mean (95% CI) (%)

P value

*The GLS was reduced significantly after 3 weeks. CI: confidence interval; GLS: global longitudinal strain; LVEF: left ventricular ejection fraction; SD: standard deviation.

GLS

-20.7 ± 2.4

-19.1 ± 2.8

-1.6 (-2.6 to -0.7)

0.002*

LVEF biplane

67.8 ± 4.5

65.8 ± 5.1

2.0 (-0.2 to 4.3)

0.067

**Table 3.** Comparison of the RLS Value at Baseline and 3 Weeks After the First Chemotherapy Cycle Using T-Test Analysis
Segment	Baseline, mean ± SD (%)	3 weeks, mean ± SD (%)	Difference, mean (95% CI) (%)	P value
The RLS of the basal anteroseptal, basal anterolateral, mid anterolateral, mid inferolateral, and all apical segments (*P < 0.05) were significantly reduced with the significant decline being found in apicoanterior, basal, and mid anterolateral segments. RLS: regional longitudinal strain; CI: confidence interval; SD: standard deviation.
Basal anterior	-16.8 ± 6.7	-17.1 ± 6.2	-0.3 (-2.8 - 2.2)	0.805
Basal anteroseptal	-15.0 ± 4.8	-12.1 ± 6.4	2.9 (0.7 - 5.2)	0.013*
Basal inferoseptal	-15.8 ± 3.7	-15.6 ± 3.4	0.2 (-1.2 - 1.6)	0.749
Basal inferior	-17.5 ± 3.6	-17.3 ± 3.6	0.2 (-1.4 - 1.7)	0.828
Basal inferolateral	-17.9 ± 7.1	-16.8 ± 6.4	1.1 (-1.8 - 4.1)	0.433
Basal anterolateral	-19.5 ± 3.9	-17.0 ± 5.7	2.5 (0.6 - 4.4)	0.013*
Mid anterior	-19.3 ± 4.4	-18.1 ± 4.8	1.2 (-0.6 - 3.0)	0.186
Mid anteroseptal	-19.6 ± 4.7	-18.0 ± 4.2	1.6 (-0.3 - 3.6)	0.092
Mid inferoseptal	-21.1 ± 3.6	-19.9 ± 3.0	1.3 (-0.1 - 2.6)	0.062
Mid inferior	-20.8 ± 2.9	-20.3 ± 3.6	0.4 (-0.8 - 1.7)	0.472
Mid inferolateral	-21.5 ± 3.2	-19.4 ± 3.2	2.1 (1.0 - 3.3)	0.001*
Mid anterolateral	-18.9 ± 3.9	-16.7 ± 5.0	2.2 (0.5 - 3.9)	0.012*
Apicoanterior	-24.9 ± 5.1	-21.0 ± 8.1	3.9 (1.3 - 6.5)	0.004*
Apicoseptal	-26.3 ± 5.3	-23.9 ± 4.6	2.3 (0.1 - 4.5)	0.038*
Apicoinferior	-26.9 ± 4.6	-24.0 ± 5.9	3.0 (0.7 - 5.2))	0.010*
Apicolateral	-24.7 ± 4.5	-21.4 ± 5.3	3.3 (1.0 - 5.5)	0.005*
Apical cap	-25.9 ± 4.2	-22.6 ± 5.3	3.3 (1.2 - 5.3)	0.003*

Table 3. Comparison of the RLS Value at Baseline and 3 Weeks After the First Chemotherapy Cycle Using T-Test Analysis

Segment

Baseline, mean ± SD (%)

3 weeks, mean ± SD (%)

Difference, mean (95% CI) (%)

P value

The RLS of the basal anteroseptal, basal anterolateral, mid anterolateral, mid inferolateral, and all apical segments (*P < 0.05) were significantly reduced with the significant decline being found in apicoanterior, basal, and mid anterolateral segments. RLS: regional longitudinal strain; CI: confidence interval; SD: standard deviation.

Basal anterior

-16.8 ± 6.7

-17.1 ± 6.2

-0.3 (-2.8 - 2.2)

0.805

Basal anteroseptal

-15.0 ± 4.8

-12.1 ± 6.4

2.9 (0.7 - 5.2)

0.013*

Basal inferoseptal

-15.8 ± 3.7

-15.6 ± 3.4

0.2 (-1.2 - 1.6)

0.749

Basal inferior

-17.5 ± 3.6

-17.3 ± 3.6

0.2 (-1.4 - 1.7)

0.828

Basal inferolateral

-17.9 ± 7.1

-16.8 ± 6.4

1.1 (-1.8 - 4.1)

0.433

Basal anterolateral

-19.5 ± 3.9

-17.0 ± 5.7

2.5 (0.6 - 4.4)

0.013*

Mid anterior

-19.3 ± 4.4

-18.1 ± 4.8

1.2 (-0.6 - 3.0)

0.186

Mid anteroseptal

-19.6 ± 4.7

-18.0 ± 4.2

1.6 (-0.3 - 3.6)

0.092

Mid inferoseptal

-21.1 ± 3.6

-19.9 ± 3.0

1.3 (-0.1 - 2.6)

0.062

Mid inferior

-20.8 ± 2.9

-20.3 ± 3.6

0.4 (-0.8 - 1.7)

0.472

Mid inferolateral

-21.5 ± 3.2

-19.4 ± 3.2

2.1 (1.0 - 3.3)

0.001*

Mid anterolateral

-18.9 ± 3.9

-16.7 ± 5.0

2.2 (0.5 - 3.9)

0.012*

Apicoanterior

-24.9 ± 5.1

-21.0 ± 8.1

3.9 (1.3 - 6.5)

0.004*

Apicoseptal

-26.3 ± 5.3

-23.9 ± 4.6

2.3 (0.1 - 4.5)

0.038*

Apicoinferior

-26.9 ± 4.6

-24.0 ± 5.9

3.0 (0.7 - 5.2))

0.010*

Apicolateral

-24.7 ± 4.5

-21.4 ± 5.3

3.3 (1.0 - 5.5)

0.005*

Apical cap

-25.9 ± 4.2

-22.6 ± 5.3

3.3 (1.2 - 5.3)

0.003*