Author + information
- Paaladinesh Thavendiranathan, MD, MSc∗ ( and )
- Thomas H. Marwick, MD, PhD, MPH
- ↵∗Peter Munk Cardiac Center, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
We thank Dr. Drinković for the interest in our State-of-the-Art Paper (1). Studies based on histology (2), echocardiography, and/or nuclear imaging (3) all recognize the possibility of regional involvement from cardiotoxicity. Abnormal regional myocardial strain assessment—which is more sensitive for identifying regional functional abnormalities than visual assessment alone—has been described, particularly with anthracycline therapy (4). However, none of these studies has reported a consistent pattern of regional wall motion abnormalities. Additionally, we are unaware of publications that have demonstrated a relationship between a particular regional pattern of wall motion abnormalities with cardiomyopathy or heart failure.
In clinical practice, we have not noticed the specific pattern of inferolateral wall motion abnormality mentioned by Dr. Drinković, although we have not evaluated this systematically. Nonetheless, the occurrence of visibly detectable regional wall abnormalities during cancer chemotherapy may signify significant myocardial injury and may be associated with a reduction in left ventricular ejection fraction. Whether management decisions based on such findings will improve outcomes such as the development of heart failure is unknown. Studies focused on a regional approach are likely to be limited by the impact of artifact and apparently random variation of regional strain values, as well as the known interobserver variation of regional wall motion assessment. At present, the expert consensus document on multimodality imaging evaluation of adult patients during and after therapy proposes changes of global strain to define cardiotoxicity (5).
- American College of Cardiology Foundation
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- Poulin F.,
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- Marwick T.H.
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