Skip to main content

2D longitudinal LV speckle tracking strain pattern in breast cancer survivors: sports activity vs exercise as prescription model


Prevention strategies are important to optimize and to manage heart care in breast cancer survivors. Regular physical activity at moderate intensity is normally proposed to maintain myocardial performance; however, no data is available about the different impact of different levels of physical exercise. 2D speckle tracking echocardiography (2DSTE) is an accepted method for early detection of myocardial dysfunction. The study aims to monitor the cardiac performances in breast cancer survivors by 2DSTE analysis to manage sports activity vs physical activity. Two groups of previous breast cancer survivors (33 BCS) trained at moderate intensity and 55 athletes practicing dragon boat (DBA) sport were enrolled. They were matched with two healthy subjects groups: 23 competitive female athletes practicing different sports and 20 healthy women trained with exercise as prescription model. All women were studied by a complete echo examination including LV global longitudinal strain (GLS) assessment (XStrain-Esaote). EF and GS are only significantly higher in healthy subjects (−25.4 ± 2.1). Nevertheless, GLS values are within the normal range for all groups. Particularly, GS does not show any significant differences among subjects (−19.93 ± 4) practicing exercise as prescription when compared to the DBA competitive trained group. 2DSTE method is an appropriate method to supervise the intensity of exercise in breast cancer patients. Particularly, GLS can optimize and improve cancer therapy supporting and creating efficiencies within the health system confirming the role of the exercise prescription therapy in maintaining normal heart function.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Jemal A, Bray F, Center MM, Ferlay J et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90

    Article  PubMed  Google Scholar 

  2. 2.

    Coleman MP, Forman D, Bryant H et al (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377:127–138

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hooning MJ, Botma A, Aleman BM et al (2007) Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 99:365–375

    Article  PubMed  Google Scholar 

  4. 4.

    Coleman MP, Quaresma M, Berrino F, CONCORD Working Group et al (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9:730–756

    Article  PubMed  Google Scholar 

  5. 5.

    Patel SA, Heinrich AC, Reddy BY, Rameshwar P (2009) Inflammatory mediators: parallel between cancer biology and stem cell therapy. J Inflamm Res. 1(2):13–19

    Google Scholar 

  6. 6.

    Petersen AM, Pedersen BK (2005) The anti-inflammatory effect of exercise. J Appl Physiol 98(4):1154–1162

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Jacquinot Q, Meneveau N, Chatot M et al (2017) A phase 2 randomized trial to evaluate the impact of a supervised exercise program on cardiotoxicity at 3 months in patients with HER2 overexpressing breast cancer undergoing adjuvant treatment by trastuzumab: design of the CARDAPAC study. BMC Cancer 17(1):425

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Calle EE, Rodriguez C, Walker-Thurmond K et al (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638

    Article  PubMed  Google Scholar 

  9. 9.

    Jones LW, Alfano CM (2013) Exercise-oncology research: past, present, and future. Acta Oncol 52(2):195–215. doi:10.3109/0284186X.2012.742564

    Article  PubMed  Google Scholar 

  10. 10.

    Stefani L, Galanti G, Di Tante V et al (2015) Dragon Boat training exerts a positive effect on myocardial function in breast cancer survivors. Phys Sportsmed 43(3):307–311. doi:10.1080/00913847.2015.1037711

    Article  PubMed  Google Scholar 

  11. 11.

    Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH (2014) 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 63:2751–2768

    Article  PubMed  Google Scholar 

  12. 12.

    Negishi K, Negishi T, Hare JL et al (2013) Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr 26:493–498

    Article  PubMed  Google Scholar 

  13. 13.

    Geyer H, Caracciolo G, Abe H et al (2010) Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 23:351–369

    Article  PubMed  Google Scholar 

  14. 14.

    Levine BD, Baggish AL, Kovacs RJ et al (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 1: classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66(21):2350–2355. doi:10.1016/j.jacc.2015.09.033

    Article  PubMed  Google Scholar 

  15. 15.

    Gibbons RJ, Balady GJ, Bricker JT et al (2006) AHA ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 48:1731

    Article  Google Scholar 

  16. 16.

    Enright PL (2003) The sixt-minute walk test. Respir Care 48:783–785

    PubMed  Google Scholar 

  17. 17.

    Daum CW, Cochrane SK, Fitzgerald JD et al (2016) Exercise interventions for preserving physical function among cancer survivors in middle to late life. J Frailty Aging 5(4):214–224

    CAS  PubMed  Google Scholar 

  18. 18.

    ACSM (2013) Guidelines for exercise testing and prescription, 9th edn. Lippincott Williams &Wilkins: Philadelphia. Accessed 1 July 2013

  19. 19.

    Stefani L, Galanti G, Klika R (2017) Clinical implementation of exercise guidelines for cancer patients: adaptation of ACSM’s guidelines to the Italian model. J Funct Morphol Kinesiol 2:4. doi:10.3390/jfmk2010004

    Article  Google Scholar 

  20. 20.

    Stefani L, Petri C, Mascherini G et al (2016) Lifestyle intervention in surviving cancer patients. J Funct Morphol Kinesiol 1:48–53. doi:10.3390/jfmk1010048

    Article  Google Scholar 

  21. 21.

    McHorney CA, Ware JE, Raczek AE (1993) The MOS 36-Itern Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Panagiotakos DB, Pitsavos C, Arvaniti F et al (2007) Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med 44:335–340

    Article  PubMed  Google Scholar 

  23. 23.

    Robertson RJ, Goss FL, Dubé J et al (2004) Validation of the adult OMNI scale of perceived exertion for cycle ergometer exercise. Med Sci Sports Exerc 36:102–108

    Article  PubMed  Google Scholar 

  24. 24.

    ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR (2011) Appropriate use criteria for echocardiography. J Am Soc Echocardiogr 2011(24):229–267. doi:10.1016/j.echo.2010.12.008

    Google Scholar 

  25. 25.

    Ganau A, Devereux RB, Roman MJ et al (1992) Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 19(7):1550–1558

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Voigt JU, Pedrizzetti G, Lysyansky P et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Cardiovasc Imaging 16:1–11

    CAS  Google Scholar 

  27. 27.

    Vitarelli A, Capotosto L, Placanica G et al (2013) Comprehensive assessment of biventricular function and aortic stiffness in athletes with different forms of training by three-dimensional echocardiography and strain imaging. Eur Heart J Cardiovasc Imaging 14:1010–1020

    Article  PubMed  Google Scholar 

  28. 28.

    Simsek Z, Hakan Tas M, Degirmenci H et al (2013) Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling. Echocardiography 30(10):1202–1208

    Article  PubMed  Google Scholar 

  29. 29.

    Scott JM, Khakoo A, Mackey JR et al (2011) Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer: current evidence and underlying mechanisms. Progress Cardiovasc Dis 124(5):642–650. doi:10.1161/CIRCULATIONAHA.111.02177

    Google Scholar 

  30. 30.

    Herbst RS, Bajorin DF, Bleiberg H et al (2006) Clinical cancer advances 2005: major research advances in cancer treatment, prevention, and screening. A report from the American Society of Clinical Oncology. J Clin Oncol 24:190–205

    Article  PubMed  Google Scholar 

  31. 31.

    Pituskin E, Mackey JR, Koshman S et al (2016) 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. doi:10.1200/JCO.2016.68.7830

    PubMed  Google Scholar 

  32. 32.

    Stefani L, Pedrizzetti G, Galanti G (2016) Clinical application of 2D speckle tracking strain for assessing cardio-toxicity in oncology. J Funct Morphol Kinesiol 1:343–354. doi:10.3390/jfmk1040343

    Article  Google Scholar 

  33. 33.

    Stefani L, Pedrizzetti G, De Luca A, Mercuri R, Innocenti G, Galanti G (2009) Real-time evaluation of longitudinal peak systolic strain (speckle tracking measurement) in left and right ventricles of athletes. Cardiovasc Ultrasound. 7:17

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Curigliano G, Mayer EL, Burstein HJ et al (2010) Cardiac toxicity from systemic cancer therapy: a comprehensive review. Prog Cardiovasc Dis 53(2):94–104

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Franklin BA, Swain DP, Shephard RJ (2003) New insights in the prescription of exercise for coronary patients. J Cardiovasc Nurs 18(2):116–123

    Article  PubMed  Google Scholar 

  36. 36.

    Lipsett A, Barrett S, Haruna F et al (2017) A The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: a systematic review and meta-analysis. Breast 8(32):144–155. doi:10.1016/j.breast.2017.02.002

    Article  Google Scholar 

  37. 37.

    Bouillon K, Haddy N, Delaloge S et al (2011) Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol 57:445–452

    Article  PubMed  Google Scholar 

  38. 38.

    Rhea IB, Uppuluri S, Sawada S, Schneider BP et al (2015) Incremental prognostic value of echocardiographic strain and its association with mortality in cancer patients. J Am Soc Echocardiogr. doi:10.1016/j.echo.2015.02.006

    PubMed  Google Scholar 

  39. 39.

    Bourke L, Homer KE, Thaha MA, Steed L et al (2014) Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review. Br J Cancer 110:831–841. doi:10.1038/bjc.2013.750

    CAS  Article  PubMed  Google Scholar 

Download references


No funds or grant have been received for the manuscript.

Author information




GG has deeply implemented the aim of the study contributing to the meaning in the exercise prescription application; GP has supported the statistical approach of the study, the significance of the strain analysis and the application of the method in this context; SP has strongly supported the technical aspects of the method used in terms of validity of the system; LS has conceived, written and revised the study. She has also coordinated the planning of protocol.

Corresponding author

Correspondence to Laura Stefani.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

The protocol was approved by the local ethical committee, in agreement with the Human and animal rights statement.

Informed consent

All the subjects enrolled gave their consent to participate to the investigation.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Galanti, G., Pedrizzetti, G., Pedri, S. et al. 2D longitudinal LV speckle tracking strain pattern in breast cancer survivors: sports activity vs exercise as prescription model. Intern Emerg Med 12, 1149–1157 (2017).

Download citation


  • Breast cancer
  • Physical exercise
  • Sports
  • Global longitudinal strain
  • 2D speckle tracking echocardiography
  • 2DSTE