AIMS This study assessed the impact of the strain-guided therapeutic approach on cancer therapy-related cardiac dysfunction (CTRCD) and rate of cancer therapy (CT) interruption in breast cancer. METHODS AND RESULTS We enrolled 116 consecutive female patients with HER2-positive breast cancer undergoing a standard protocol by EC (epirubicine + cyclophosphamide) followed by paclitaxel + trastuzumab (TRZ). Coronary artery, valvular and congenital heart disease, heart failure, primary cardiomyopathies, permanent or persistent atrial fibrillation, and inadequate echo-imaging were exclusion criteria. Patients underwent an echo-Doppler exam with determination of ejection fraction (EF) and global longitudinal strain (GLS) at baseline and every 3 months during CT. All patients developing subclinical (GLS drop >15%) or overt CTRCD (EF reduction <50%) initiated cardiac treatment (ramipril+ carvedilol). In the 99.1% (115/116) of patients successfully completing CT, GLS and EF were significantly reduced and E/e' ratio increased at therapy completion. Combined subclinical and overt CTRCD was diagnosed in 27 patients (23.3%), 8 at the end of EC and 19 during TRZ courses. Of these, 4 (3.4%) developed subsequent overt CTRCD and interrupted CT. By cardiac treatment, complete EF recovery was observed in two of these patients and partial recovery in one. These patients with EF recovery re-started and successfully completed CT. The remaining patient, not showing EF increase, permanently stopped CT. The other 23 patients with subclinical CTRCD continued and completed CT. CONCLUSION These findings highlight the usefulness of 'strain oriented' approach in reducing the rate of overt CTRCD and CT interruption by a timely cardioprotective treatment initiation.

中文翻译：

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以应变为导向的策略，指导经历心脏功能障碍的乳腺癌患者的心脏保护启动。

目的本研究评估了应变引导治疗方法对乳腺癌中与癌症治疗相关的心脏功能障碍（CTRCD）和癌症治疗（CT）中断率的影响。方法和结果我们招募了116名连续接受HER2阳性乳腺癌的女性患者，这些患者接受了EC（依比比星+环磷酰胺），紫杉醇+曲妥珠单抗（TRZ）的标准方案治疗。排除标准是冠状动脉，瓣膜和先天性心脏病，心力衰竭，原发性心肌病，永久性或持续性心房纤颤以及回声成像不足。患者接受回声多普勒检查，确定基线时以及CT期间每3个月的射血分数（EF）和总体纵向应变（GLS）。所有患者均出现亚临床（GLS下降> 15％）或明显CTRCD（EF降低< 50％）开始心脏治疗（雷米普利+卡维地洛）。在成功完成CT的99.1％（115/116）患者中，治疗完成时GLS和EF明显降低，E / e'比增加。在27例（23.3％）患者中，诊断为亚临床和明显的CTRCD合并，在EC末期诊断为8例，在TRZ疗程中诊断为19例。其中4（3.4％）人随后出现明显的CTRCD，并中断了CT。通过心脏治疗，在其中两名患者中观察到完全EF恢复，在一名患者中观察到部分恢复。这些EF恢复的患者重新开始并成功完成了CT。其余未显示EF增加的患者永久停止了CT检查。其余23例亚临床CTRCD患者继续并完成了CT检查。结论这些发现强调了“以应变为导向”的有用性。