Left ventricular systolic function in HER2/neu negative breast cancer patients treated with anthracycline chemotherapy: a comparative analysis of left ventricular ejection fraction and myocardial strain imaging over 12 months

Eur J Cancer. 2013 Nov;49(16):3396-403. doi: 10.1016/j.ejca.2013.06.046. Epub 2013 Aug 9.


Aim: Anthracycline agents are undermined by their cardiotoxicity. As life expectancy following treatment is greatly improved, techniques that ensure early detection and timely management of cardiotoxicity are essential. The aim of the present study was to evaluate left ventricular (LV) systolic function with LV ejection fraction (LVEF) and two-dimensional myocardial strain up to 12 months after anthracycline chemotherapy, specifically in HER2/neu negative breast cancer patients.

Methods: Seventy-eight consecutive anthracycline naïve breast cancer patients were studied before and immediately after anthracycline chemotherapy. Fifty HER2/neu negative patients were studied over 12 months with serial echocardiograms at four time points. All patients were treated with standard regimens containing anthracyclines.

Results: Global systolic strain was significantly reduced immediately after, and 6 months after anthracyclines (-19.0 ± 2.3% to -17.5 ± 2.3% (P<0.001) and -18.2 ± 2.2% (P=0.01) respectively). A non-uniform reduction in strain was observed each time with relative sparing of the LV apex. LVEF remained largely unchanged at both time points. Global strain normalised by 12 months in the majority of patients. Persistently reduced strain was observed in 16% (n=8); these patients had a greater reduction in strain at 6 months (≤ -17.2%), and had received higher cumulative anthracycline doses.

Conclusion: Myocardial strain imaging is more sensitive than LVEF for the early detection and intermediate term monitoring of LV systolic function following anthracycline chemotherapy in HER2/neu negative breast cancer patients, and may aid in the development of improved monitoring protocols.

Keywords: Anthracyclines; Breast cancer; Echocardiography; Myocardial contraction.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Anthracyclines / adverse effects*
  • Antibiotics, Antineoplastic / adverse effects*
  • Biomarkers, Tumor / analysis*
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Breast Neoplasms, Male / chemistry
  • Breast Neoplasms, Male / drug therapy*
  • Breast Neoplasms, Male / pathology
  • Chi-Square Distribution
  • Early Diagnosis
  • Echocardiography, Doppler
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Myocardial Contraction / drug effects*
  • Predictive Value of Tests
  • Receptor, ErbB-2 / analysis*
  • Risk Factors
  • Stroke Volume / drug effects*
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Left / chemically induced*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / drug effects*


  • Anthracyclines
  • Antibiotics, Antineoplastic
  • Biomarkers, Tumor
  • ERBB2 protein, human
  • Receptor, ErbB-2