Table 4. Strain imaging in the assessment of chemotherapy associated cardio toxicity.

Study	Sample size with description	Imaging modality with vendor name	Objective	Outcomes
Tsai et al. [40]	Hodgkin's lymphoma and radiotherapy (n=47) [AT (n=27), No AT (n=20)] vs. controls (n=20)	2D-ECHO and 2D-STE (EchoPAC-GE)	LV dysfunction with anthracycline (AT) and radiotherapy (RT)	Higher GLS impairment in RT+AT (-16.1%) than RT and no AT (-17.5%); CS-similar trend; pEF-all groups
Poterucha et al. [31]	AT (n=19) vs. controls (n=19)	2D-ECHO and 2D-STE (EchoPAC-GE)	Temporal changes in strain and LVEF	Longitudinal PSS reduction started at 4 months (8.7%) and worsened by 8 months (9.2%) with AT. LVEF decreased by 4.3% only at 8 months.
Motoki et al. [32]	AT therapy (n=25)	2D-ECHO, TDI and 2D-STE (EchoPAC-GE)	Torsional strain and subclinical LV dysfunction	Impairment in GLS, TS, twisting and untwisting rates occur as early as 1 month; LVEF, TDI indices-preserved
Ho et al. [49]	AT (n=19) vs. AT+TZ (n=51) vs. controls (n=50)	2D-ECHO, Doppler ECHO and 2D-STE (EchoPAC-GE)	Subclinical LV dysfunction in combination therapy (AT+TZ)	Reduced GLS in AT (-17.7) vs. AT+TZ (-19.2) vs. controls (-19.6). No additive cardiotoxicity with TZ
Fallah-Rad et al. [50]	No toxicity (n=10) vs. TZ toxicity (n=32)	TVI, CMR and 2D-STE (EchoPac-GE)	Detection of TZ cardiotoxicity with various techniques	2D-STE impairment in GLS (-19.9 ± 1.8% to. -16.4 ± 1.1%) and GRS (42.4 ± 10.5% to. 32.5 ± 15.2%) occur earliest (3 months). LVEF preserved until 6 months

2D-ECHO, 2 dimensional echocardiography; 2D-STE, 2 dimensional speckle tracking echocardiography; AT, anthracycline; CMR, cardiac magnetic resonance; CS, circumferential strain; GLS, global longitudinal strain; GRS, global radial strain; LV, left ventricle; LVEF, left ventricular ejection fraction; pEF, preserved ejection fraction; PSS, peak systolic strain; RS, radial strain; RT, radiotherapy; TS, torsional strain; TDI, tissue Doppler imaging; TZ, trastuzumab.