No Gains From Escalating Chemo Cardiotoxicity Echo-Strain Tests

Abdullah Hashmi, MD, for Medscape

August 25, 2022

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaways

  • The prevalence of subclinical cardiotoxicity identified by echocardiographic global longitudinal strain (GLS) in patients with breast cancer taking doxorubicin (Adriamycin) was similar whether assessed at 3-week intervals or 3-month intervals.

  • It was also similar regardless of echocardiography global longitudinal strain (GLS) criteria for identifying subclinical cardiotoxicity.

  • Quarterly monitoring of GLS in such patients, compared with assessments every 3 weeks, is therefore adequate.

Why This Matters

  • Serial assessment of left ventricular ejection fraction (LVEF) by standard echocardiography is not very sensitive for picking up early cardiotoxic changes in patients with breast cancer taking doxorubicin.

  • Serial echocardiography with GLS assessment is useful for detecting preclinical chemotherapy cardiotoxicity effects, but there is little consensus on how often to perform such assessments or the optimal GLS criteria.

Study Design

  • The prospective, longitudinal observational study, conducted from April 2019 to June 2021, entered 43 women with breast cancer receiving doxorubicin at a single center in Goiania, Brazil.

  • Exclusion criteria included heart disease (heart failure, coronary artery disease, congenital heart disease, cardiomyopathies, or stage 3 hypertension), LVEF <50% or moderately severe or severe valvular disease, and inadequate transthoracic echocardiography (TTE) acoustic window.

  • Patients underwent TTE with GLS assessment before starting chemotherapy and at 3-week intervals that coincided cycles of doxorubicin administration. They underwent a maximum of nine tests over 6 months of follow-up.

Key Results

  • None of the 43 women developed clinical cardiotoxicity.

  • When cardiotoxicity was defined by more than a 15% relative reduction in absolute GLS value, it was present in 28% of patients based on tests performed at 3-week intervals and 14% when counting tests performed every 3 months (P = .28).

  • When the GLS criterion was set at greater than 12%, subclinical cardiotoxicity was present in 39.5% of patients for tests at 3-week intervals and 23.3% of patients for tests at 3 month intervals (P = .16)

  • Neither absolute GLS value cut point was associated with a different rate of subclinical cardiotoxicity detection using either the every-3-week (P = .19) or every-3-month (P = .41) assessments.

  • Age 60 or older (P = .018) and having hypertension (P = .022) were associated with subclinical cardiotoxicity in unadjusted analysis.


  • A short follow-up period, small patient population, and low cumulative doxorubicin dose may help explain the low rates of subclinical cardiotoxicity.

  • Biomarker assessments and cardiac MRI, not used in the study, might have provided additional diagnostic value.


  • The study received no external funding.

  • The authors declare they have no competing interests.

This is a summary of a preprint research study, "Echocardiographic  strategy for early detection of cardiotoxicity of doxorubicin: A prospective observational study," written by researchers at the Federal University of Goias, Goiania, Brazil and the Hospital das Clinicas of the Federal University of Goias, Brazil on ResearchSquare, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.