Table. Summary of Included Studies.
| Source | Cancer Type, % | Treatment, % | Study Type | CTRCD Definitiona | Follow-up, mo | Age, y | Female, % | Baseline | Echo Vendor | Analysis Software Vendor | GLS Follow-up, mo | Study Size, No. | CTRCD, % | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LVEF, % | GLS, −% | |||||||||||||
| Studies Examining the Prognostic Value of Absolute or Relative GLS Cutoff Values | ||||||||||||||
| Baratta et al,11 2013 | Breast, 44.4; lymphoma-leukemia, 30.6; other, 25.0 | Doxorubicin, 58.3; TZM, 22.2; mitoxantrone, 2.8; other, 16.7 | Prospective | CREC | Mean: 6 | Mean: 47 | 41.7 | Mean (SD): 65 (7) | Mean (SD): 20.3 (2.7)b | Vivid 7 (GE) | EchoPAC (GE) | 3 | 36 | 19.4 |
| Charbonnel et al,20 2017 | HL, 45; NHL, 49; acute leukemia, 6 | ANT, 100 | Prospective | ASE/EACVI | Mean: 12 | Median (IQR): 48 (30-64) | 36 | Median (IQR): 66 (62-69) | Median (IQR): 21.1 (19.3-23.1) | Vivid E9 (GE) | EchoPAC (GE) | 3 | 86 | 9.3 |
| Gripp et al,21 2018 | Breast, 100 | ANT only, 83.7; ANT with TZM, 16.3 | Prospective | CREC | Mean (SD): 12.7 (1.0) | Mean: 50 | 100 | Mean: 68 | Mean: 20.4 | Vivid S6 (GE) | EchoPAC (GE) | 3 | 49 | 10.2 |
| Fallah-Rad et al,22 2011 | Breast, 100 | ANT with TZM, 12; FEC with TZM, 88 | Prospective | CREC | Mean: 12 | Mean (SD): 47 (9) | 100 | Mean: 63 | Mean: 20.1 | Vivid 7 (GE) | EchoPAC (GE) | 3 | 42 | 23.8 |
| Florescu et al,23 2014 | Breast, 100 | ANT, 100 | Prospective | CREC | Mean (SD): 4.2 (0.4) | Mean (SD): 51 (8) | 100 | Mean (SD): 60 (4) | Mean (SD): 23.1 (1.7) | Vivid 7 Dimension (GE) | EchoPAC (GE) | Mean: 2.1 | 40 | 35.0 |
| Guerra et al,24 2016 | Breast, 100 | CP, 62; ANT, 59; taxanes, 23; TZM, 17; 5-FU, 16c | Prospective | CREC/ESMO | Mean: 12 | Mean (SD): 56 (13) | 96 | Mean: 64 | Mean: 19.8 | Vivid 7 Pro (GE) | EchoPAC (GE) | 3 | 69 | 27.5 |
| Kang et al,25 2013 | NHL, 100 | ANT with R-CHOP, 100 | Prospective | CREC | Range: 4-6 | Mean (SD): 54 (14) | 45.3 | Mean (SD): 65 (4) | Mean (SD): 18.5 (1.7) | iE33 (Philips) | QLAB (Philips) | 2 to 3 | 75 | 18.7 |
| Milks et al,26 2018 | Breast, 100 | ANT only, 58.8; ANT with TZM, 41.2 | Retrospective | ASE/EACVI | NA | Mean (SD): 51 (11) | 100 | Mean: 59 | Mean: 22.4 | Several | Image-Arena (TomTec) | Clinical time points | 183 | 18.0 |
| Mornoş and Petrescu,27 2013 | Breast, 44.6; NHL, 20.3; HL, 17.6; ALL, 12.1; AML, 2.7; osteosarcoma, 2.7 | ANT, 100 | Prospective | CREC | Mean: 12 | Mean (SD): 51 (11) | 58.1 | Mean (SD): 61 (6) | Mean (SD): 21.2 (2.5) | Vivid 7 (GE) | EchoPAC Dimension (GE) | 1.5 | 74 | 13.5 |
| Mornoş et al,28 2014 | Breast, 44.1; NHL, 20.3; HL, 16.9; ALL, 13.6; AML, 3.4; osteosarcoma, 1.7 | ANT, 100 | Prospective | CREC | Mean: 8.4 | Mean (SD): 51 (10) | 59.3 | Mean (SD): 60 (6) | Mean (SD): 20.1 (3.7) | Vivid 9 (GE) | EchoPAC Dimension (GE) | 3 | 59 | 13.6 |
| Negishi et al,12 2013 | Breast (EGFR2+), 100 | TZM with or without ANT, 45.7; TZM with or without taxanes, 91.4c | Prospective | ≥10% Reduction in LVEF | Mean: 12 | Mean (SD): 50 (11) | 10 | Mean (SD): 62 (4) | Mean (SD): 20 (2) | Vivid 7 or E9 (GE) | EchoPAC (GE) | 6 | 81 | 29.6 |
| Paraskevaidis et al,29 2017 | BMT for NHL, 50; AML, 40; CML, 10 | BMT, 100d | Prospective | ASE/EACVI | Mean: 12 | Mean (SD): 45 (11) | 45 | Mean (SD): 59 (4)e | Mean (SD): 20 (2.2) | Vivid 7 (GE) | EchoPAC (GE) | 1 | 80 | 17.5 |
| Portugal et al,30 2017 | Breast, 100 | ANT only, 67; ANT with TZM, 33 | Prospective | ASE/EACVI | Mean: 5.4 | Mean (SD): 55 (13) | 100 | Mean (SD): 62 (8) | Mean (SD): 20.1 (3.5) | Vivid 7 or E9 (GE) | EchoPAC BT12 (GE) | Mean: 3.6 | 158 | 19.0 |
| Sawaya et al,31 2012 | Breast (EGFR2+), 100 | ANT with taxanes and TZM, 100 | Prospective | CREC | Mean: 15 | Mean (SD): 50 (18) | 100 | Mean (SD): 64 (5) | Mean (SD): 21 (2)b | Vivid 7 or E9 (GE) | EchoPAC (GE) | 3 | 81 | 32.1 |
| Sawaya et al,32 2011 | Breast (EGFR2+), 100 | ANT with taxanes and TZM, 100 | Prospective | CREC | Mean: 6 | Mean: 49 | 100 | Mean (SD): 65 (6) | Mean (SD): 20.5 (2.2)b | Vivid 7 or E9 (GE) |
EchoPAC (GE) | 3 | 43 | 20.9 |
| Tang et al,33 2017 | Breast, 100 | ANT, 100 | Retrospective | ASE/EACVI | Mean: 5.1 | Mean (SD): 49 (8) | 100 | Mean (SD): 65 (6) | Mean (SD): 17.9 (2.8) | Vivid E9 (GE) | EchoPAC (GE) | Median: 2.5 | 86 | 16.3 |
| Studies With No GLS Cutoff Values Identified or Examined | ||||||||||||||
| Fei et al,34 2016 | Breast, 100 | ANT with TZM, 100 | Retrospective | ASE/EACVI | Median (IQR): 17 (13-38) | Mean (SD): 47 (11) | 100 | Mean (SD): 68 (5) | Mean (SD): 22.2 (2) | Vivid 7 or E9 (GE) or iE33 (Philips) | 2D Cardiac Performance Analysis (TomTec) | Mean: 1.5 | 95 | 20.0 |
| Lorenzini et al,35 2013 | Breast, 100 | ANT with TZM, 100 | Prospective | CREC | Mean: 7.4 | Mean (SD): 53 (11) | NA | Mean (SD): 58 (4.8) | Mean: 19.9 | Vivid E9 (GE) | EchoPAC (GE) | 4 | 65 | 36.9 |
| Narayan et al,36 2016 | Breast, 100 | ANT only, 67; TZM only, 15; ANT with TZM, 18 | Prospective | ≥10% reduction in LVEF from baseline to <50% after treatment initiation | Median (IQR): 23 (11-29) | Median (IQR): 48 (41-57) | 100 | Median (IQR): 54 (51-56) | Median (IQR): 16.1 (17.7-14)f | Vivid 7 or E9 (GE) or iE33 (Philips) | 2D Cardiac Performance Analysis (TomTec) | Variable depending on treatment regimen | 135 | 15.6 |
| Narayan et al,37 2017 | Breast, 61; lymphoma, 29; leukemia, 6; sarcoma, 4 | ANT only, 92; ANT with TZM, 8 | Prospective | ≥10% reduction in LVEF from baseline to <50% after treatment initiation | Median (IQR): 7 (6-12) | Mean (SD): 53 (13) | 77 | Mean (SD): 50 (6) | Mean (SD): 14.9 (2.8)f | GE, Philips, and Sequoia platforms | 2D Cardiac Performance Analysis (TomTec) | 6 | 165 | 18.8 |
| Shaikh et al,38 2016 | AML, 100 | Mitoxantrone, 100 | Retrospective | CREC | Mean: 6 | Mean: 62 | 45 | Mean: 65 | Mean: 15.8 | Vivid 7 (GE) | TomTec | Mean: 1.8 | 80 | 43.8 |
Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myelocytic leukemia; ANT, anthracyclines; ASE, American Society of Echocardiography; BMT, bone marrow transplant; CML, chronic myeloid leukemia; CP, cyclophosphamide; CREC, Cardiac Review and Evaluation Committee; CTRCD, cancer therapy–related cardiac dysfunction; EACVI, European Association for Cardiovascular Imaging; EGFR, epidermal growth factor receptor; ESMO, European Society for Medical Oncology; FEC, combination of 5-FU, epirubicin, and CP; 5-FU, 5-fluorouracil; GLS, global longitudinal strain; HL, Hodgkin lymphoma; IQR, interquartile range; LVEF, left ventricular ejection fraction; NA, not applicable; NHL, non-Hodgkin lymphoma; R-CHOP, rituximab, doxorubicin, vincristine, cyclophosphamide, and prednisone; TZM, trastuzumab.
Cardiotoxicity definitions: ASE/EACVI, ≥10% reduction in LVEF from baseline to <53% after treatment; CREC, ≥10% reduction in LVEF from baseline to <55% or ≥5% reduction to <55% with heart failure symptoms; ESMO, ≥20% reduction in LVEF from baseline despite normal function or to an LVEF <50%.
Strain measured from 2 rather than all 3 apical views.
Patients received different combinations of treatments, so percentages do not sum to 100.
In this study, 89% of patients had previously received ANT.
LVEF measured using 3-dimensional echocardiography.
The LV endocardial border was manually traced from the parasternal short-axis view at the midpapillary level and apical 4-chamber views.