Journal of Echocardiography

, Volume 16, Issue 1, pp 20–27 | Cite as

Echocardiographic evaluation of cardiac function after cancer chemotherapy

  • Tomoko Negishi
  • Kazuaki Negishi
Review Article


Progress in cancer therapy has led to improved prognosis of patients with cancer and thus to a continuous rise of cancer survivors. However, it has simultaneously increased cardiovascular morbidity and mortality rates due to direct and/or indirect side effects of anticancer treatment. Similar to the rapid rise of patients with adult congenital disease, the number of patients suffering or at risk of cardiotoxicity has been steeply increasing and getting an emerging issue. Among the many facets of chemotherapy-induced cardiovascular toxicity, this review attempts to summarize echocardiographic evaluation of cardiac function after cancer chemotherapy by reviewing the definition, risk factors, brief history, limitation of left ventricular ejection fraction and myocardial strain imaging, as well as the limitations of this technique.


Cancer therapy-related cardiac dysfunction Cardiotoxicity Myocardial strain Ejection fraction Anthracycline Trastuzumab 


Compliance with ethical standards

Conflict of interest

Kazuaki Negishi is supported by an award from the Select Foundation, which had no role in the preparation of this manuscript. Kazuaki and Tomoko Negishi declare that they have no conflicts of interest.


  1. 1.
    Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. New Engl J Med. 2000;342:1077–84.CrossRefPubMedGoogle Scholar
  3. 3.
    Snipelisky D, Park JY, Lerman A, et al. How to develop a cardio-oncology clinic. Heart Fail Clin. 2017;13:347–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Martin M, Esteva FJ, Alba E, et al. Minimizing cardiotoxicity while optimizing treatment efficacy with trastuzumab: review and expert recommendations. Oncologist. 2009;14:1–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Plana JC, Galderisi M, Barac A, 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. J Am Soc Echocardiogr. 2014;27:911–39.CrossRefPubMedGoogle Scholar
  6. 6.
    Ewer MS, Lippman SM. Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. J Clin Oncol. 2005;23:2900–2.CrossRefPubMedGoogle Scholar
  7. 7.
    Zamorano JL, Lancellotti P, Rodriguez Munoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:2768–801.CrossRefPubMedGoogle Scholar
  8. 8.
    Dubost M, Ganter P, Maral R, et al. A new antibiotic with cytostatic properties: rubidomycin. C R Hebd Seances Acad Sci. 1963;257:1813–5.PubMedGoogle Scholar
  9. 9.
    Tan C, Tasaka H, Yu KP, et al. Daunomycin, an antitumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with special reference to childhood leukemia. Cancer. 1967;20:333–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Jensen BV, Skovsgaard T, Nielsen SL. Functional monitoring of anthracycline cardiotoxicity: a prospective, blinded, long-term observational study of outcome in 120 patients. Ann Oncol. 2002;13:699–709.CrossRefPubMedGoogle Scholar
  11. 11.
    Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97:2869–79.CrossRefPubMedGoogle Scholar
  12. 12.
    Ewer MS, Lenihan DJ. Left ventricular ejection fraction and cardiotoxicity: is our ear really to the ground? J Clin Oncol. 2008;26:1201–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Negishi K, Negishi T, Hare JL, et al. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr. 2013;26:493–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Negishi K, Negishi T, Haluska BA, et al. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging. 2014;15:324–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Thavendiranathan P, Poulin F, Lim KD, et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63:2751–68.CrossRefPubMedGoogle Scholar
  16. 16.
    Kalam K, Marwick TH. Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: a systematic review and meta-analysis. Eur J Cancer. 2013;49:2900–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G, et al. Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol. 2010;55:213–20.CrossRefPubMedGoogle Scholar
  18. 18.
    Bosch X, Rovira M, Sitges M, Domenech A, Ortiz-Perez JT, de Caralt TM, et al. Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies: the OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies). J Am Coll Cardiol. 2013;61:2355–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Gulati G, Heck SL, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 × 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J. 2016;37:1671–80.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Pituskin E, Mackey JR, Koshman S, Jassal D, Pitz M, Haykowsky MJ, et al. Multidisciplinary approach to novel therapies in cardio-oncology research (MANTICORE 101-Breast): a randomized trial for the prevention of trastuzumab-associated cardiotoxicity. J Clin Oncol. 2017;35:870–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Otterstad JE, Froeland G, St John Sutton M, Holme I. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur Heart J. 1997;18:507–13.CrossRefPubMedGoogle Scholar
  22. 22.
    Negishi K, Negishi T, Kurosawa K, et al. Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovasc Imaging. 2015;8:489–92.CrossRefPubMedGoogle Scholar
  23. 23.
    Kraigher-Krainer E, Shah AM, Gupta DK, Santos A, Claggett B, Pieske B, et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2014;63:447–56.CrossRefPubMedGoogle Scholar
  24. 24.
    Negishi K, Lucas S, Negishi T, et al. What is the primary source of discordance in strain measurement between vendors: imaging or analysis? Ultrasound Med Biol. 2013;39:714–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Yang H, Marwick TH, Fukuda N, et al. Improvement in strain concordance between two major vendors after the strain standardization initiative. J Am Soc Echocardiogr. 2015;28(642–8):e7.Google Scholar
  26. 26.
    Farsalinos KE, Daraban AM, Unlu S, et al. Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr. 2015;28(1171–81):e2.Google Scholar
  27. 27.
    Negishi T, Negishi K, Thavendiranathan P, et al. Effect of experience and training on the concordance and precision of strain measurements. JACC Cardiovasc Imaging. 2017;10:518–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Curigliano G, Cardinale D, Suter T, et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol. 2012;23(Suppl 7):vii155–66.CrossRefPubMedGoogle Scholar
  29. 29.
    Eschenhagen T, Force T, Ewer MS, et al. Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2011;13:1–10.CrossRefPubMedGoogle Scholar
  30. 30.
    Marwick TH. Cancer therapy-related cardiac dysfunction: unresolved issues. Can J Cardiol. 2016;32:842–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2017

Authors and Affiliations

  1. 1.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia

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