Assessing the Impact of Combined Analyses of Cardiac N-Terminal Pro-Brain Natriuretic Peptide and Global Longitudinal Strain for Early Detection of Breast Cancer Cardiotoxicity

Abstract

Background: Advances in cancer treatment have improved survival rates, but cardiovascular complications remain a concern, necessitating early detection of chemotherapy-induced cardiotoxicity. Transthoracic echocardiography, mainly left ventricular ejection fraction (LVEF), is the standard assessment tool, though it often detects later-stage dysfunction. Global longitudinal strain (GLS) offers greater sensitivity, and cardiac biomarkers like NT-pro BNP provide additional prognostic value. Current guidelines emphasize biomarker monitoring over imaging in low cardiovascular (CV) risk patients. This study evaluates the combined use of NT-pro BNP levels and left and right ventricular longitudinal strain (LVGLS and RVFWLS) for early cardiotoxicity detection in breast cancer patients receiving anthracycline therapy. Objectives: Our study aimed to evaluate the effectiveness of combined analyses of serum Cardiac N Terminal Pro Brain Natriuretic Peptide (NT-pro BNP) levels and global longitudinal strain (left ventricular global longitudinal strain (LVGLS)and right ventricular free wall longitudinal strain (RVFWLS)) in the early detection of chemotherapy-induced cardiotoxicity in low cardiovascular (CV) risk breast cancer patients receiving anthracycline therapy. Methods: A cohort of 22 female breast cancer patients receiving anthracycline chemotherapy underwent baseline and follow-up assessments, including echocardiographic parameters and NT-pro BNP measurements. Changes in longitudinal strain >15% and NT-pro BNP levels (>125pg/ml) were analyzed, along with their correlation. Results: NT-pro BNP concentration increased in 59% of cases post-chemotherapy. While left ventricle ejection fraction (LVEF) remained stable, there was a significant decrease in LVGLS -19.8±4.9 to -17.1 ± 6.0 (t-test=-3.06, df=21, p=0.006). Also, RVFWLS declined from -22.3±4.4 to -19.0 ± 4.6 (t-test=- 2.85, df=21, p=0.010). Multivariate regression analyses revealed a joint effect of LVGLS and RVFWLS on changes in NT-pro BNP levels. RVFWLS showed potential as a subtle indicator of subclinical cardiotoxicity. Conclusions: The combined assessment of NT-pro BNP levels and both left and right ventricular longitudinal strains (LVGLS and RVFWLS) demonstrates potential as an effective strategy for early detection of chemotherapy-induced cardiotoxicity in breast cancer patients with low cardiovascular risk. Specifically, RVFWLS may serve as a sensitive indicator of subclinical cardiotoxicity. However, larger-scale studies with extended follow-ups are necessary to confirm these findings, refine risk assessment, and enhance monitoring protocols in cardio-oncology.