ABC | Volume 112, Nº1, January 2019

Short Editorial Arq Bras Cardiol. 2019; 112(1):57-58 Melo e Salemi Myocardial deformation indices in preventing cardiotoxicity 1. TanC,TasakaH,YuKP,MurphyML,KarnofskyDA.Daunomycin,anantitumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with special reference to childhood leukemia. Cancer. 1967;20(3):333-53. 2. DeVita VT Jr, Rosenberg SA. Two hundred years of cancer research. N Engl J Med. 2012;366(23):2207-14. 3. Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol. 2009;53(24):2231-47. 4. Aleman BM, Moser EC, Nuver J, Suter TM, Maraldo MV, Specht L, et al. Cardiovascular disease after cancer therapy. EJC Suppl. 2014;12(1):18-28. 5. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatmentandsurvivorshipstatistics,2016.CACancerJClin.2016;66(4):271-89. 6. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014;15(10):1063-93. 7. ZamoranoJL,LancellottiP,RodriguezMuñozD,AboyansV,AsteggianoR,Galderisi M,etal.2016ESCPositionPaperoncancertreatmentsandcardiovasculartoxicity developed under the auspices of the ESC Committee for Practice Guidelines: TheTaskForceforcancertreatmentsandcardiovasculartoxicityoftheEuropean SocietyofCardiology(ESC).EurHeartJ.2016;37(36):2768-2801. 8. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. 9. Zhang KW, Finkelman BS, Gulati G, Narayan HK, Upshaw J, Narayan V, et al. Abnormalities in 3-Dimensional Left Ventricular Mechanics With Anthracycline Chemotherapy Are Associated With Systolic and Diastolic Dysfunction. JACC Cardiovasc Imaging. 2018;11(8):1059-68. 10. Okuma H, Noto N, Tanikawa S, Kanezawa K, Hirai M, Shimozawa K, et al. Impact of persistent left ventricular regional wall motion abnormalities in childhood cancer survivors after anthracycline therapy: Assessment of global left ventricular myocardial performance by 3D speckle-tracking echocardiography. J Cardiol. 2017;70(4):396-401. 11. Barros, MV. Left ventricular regional wall motion abnormality is a strong predictor of cardiotoxicity in breast cancer patients undergoing chemotherapy. Arq Bras Cardiol. 2019; 112(1):50-56. 12. Weberpals J, Jansen L, Müller OJ, Brenner H. Long-term heart- specific mortality among 347 476 breast cancer patients treated with radiotherapy or chemotherapy: a registry-based cohort study. Eur Heart J. 2018;39(43):3896-903. 13. Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity inpatientsduringandaftercancerchemotherapy:asystematic review. J Am Coll Cardiol. 2014;63(25 Pt A):2751-68. 14. Chareonthaitawee P, Kaufmann PA, Rimoldi O, Camici PG. Heterogeneity of resting and hyperemicmyocardial blood flow in healthy humans. Cardiovasc Res. 2001;50(1):151-61. 15. Dwivedi A, Axel L. Abnormal Motion Patterns of the Interventricular Septum. JACC Cardiovasc Imaging. 2017;10(10 Pt B):1281-84. 16. vanMourik MJW, Zaar DVJ, Smulders MW, Heijman J, Lumens J, Dokter JE, et al. Adding Speckle-Tracking Echocardiography to Visual Assessment of Systolic Wall Motion Abnormalities Improves the Detection of Myocardial Infarction. J Am Soc Echocardiogr. 2018;S0894-7317(18)30505-4. 17. Anwar AM. Global and segmental myocardial deformation by 2D speckle tracking compared to visual assessment.World J Cardiol. 2012;4(12):341-6. References This is an open-access article distributed under the terms of the Creative Commons Attribution License Undeniably, chemotherapy-induced cardiotoxicity is multifactorial, but perhaps such a pathophysiological hypothesis might have a clinical consequence when endothelial and coronary vasomotor functions are improved prior to exposure to chemotherapy (statins, vasodilators, beta-blockers). Of the 14 patients with altered segmental contractility, 50% of cases consisted of atypical septal movement. Nevertheless, changes in septal movement constitute a nonspecific finding, as there is an extensive range of etiologies that alter septal motility, such as conditions that cause LV volume or pressure increase; primary involvement of the cardiomyocyte (cardiomyopathies); electric conduction changes; post-surgical status; pericardial disease; congenital cardiomyopathies; post-systolic shortening and interventricular mass 15 and, therefore, one should be cautious in attributing such finding to cardiotoxicity, despite its plausibility. An alternative that would help to understand the findings would be to expose the evolution of the LV GLS fall between the different groups and to analyze if there was any similarity between the findings of segmental alterations and the parametric arrangement of LV GLS. Although the importance of myocardial deformation segmental alterations is still debatable, there are studies that have shown the incremental role of this type of analysis. 16,17 The present cohort described in the article mentioned in this editorial does not clarify how the groups were divided, making it difficult to understand how the statistical calculation was carried out. It would be interesting to have a univariate and a multivariate analysis of the factors that contributed to the ejection fraction decrease (systolic blood pressure, radiotherapy dose and site, chemotherapy dose, relative decrease in LV strain, initial absolute strain values, etc.). Moreover, a more detailed analysis of ventricular volumes and diastolic function would allow a better understanding of ventricular remodeling. Similarly, another limitation would be the inclusion of post-systolic shortening at the maximum strain peak, without considering the cardiac cycle phase. Regardless of the exposed limitations, the article shows the relevance of a limited discussed finding, the alterations in LV segmental motility during chemotherapy treatment, which may be secondary to the disease, the treatment, or the decompensation of an underlying disease. 58