Global & regional reduction of strain & function in anthracycline therapyMeasurement of LV-function before chemotherapy and in the follow-up is recommended

• EF decline of 10% and then overall <50% (50-55% decline to 40-45%) ➜ cardiotoxicity

• EF decline of overall 20% (zB 75-80% hyperdynamic EF decline to 50-55%) ➜ cardiotoxicity

• Early damage in chemotherapy: Elevation of troponin and/or GLS decline of 5% (absolute value) or GLS change of relative 12% (e.g., GLS -20% decline to -17,6% = change of absolute 2,4% = relative 12%) ➜ cardiotoxicity

• Guidelines state a relative change of GLS of 15% in overall chemotherapy

• Consequence ➜ BB, ARB or ACE-inhibitors (Troponin or GLS reduction alone ➜ already possible to start HF therapy), overall think about heart failure therapy (BB, ARNI, MRA, SGLT2i)

• Strain changes earlier compared to EF in Anthracycline therapy (follow-up 4 months EF 2% of patients showed a reduction in EF (non-significant), GLS 9% in pathological; to 8 months: EF around 4,5% reduced (statistically significant, strain stayed reduced & significant)) and stays reduced and shows early cardiotoxicity ➜ early therapy induction

• GLS before chemotherapy >-17% ➜ elevation of risk for cardiotoxicity >12,3 times (all cardiotoxic chemotherapies)

• Almost immediate reduction in GLS in therapy

• GLS improvement is evident before EF improvement under Therapy in cardiotoxicity

• LASr reduction of relative 10% and absolute <35% as a cut-off for anthracycline toxicity

• The ESC recommends a GLS measurement for all patients if feasible for those who receive echocardiography (Class 1C recommendation)

• Addendum radiation therapy — will influence apical strain and lead to a reduction (think about constriction)

• For each % of strain reduction after 4-6 months, 2% EF reduction will follow in 1-2 years

• For each % of strain improvement of GLS, 2% EF will be better in the long-term follow-up

• Early parameter in reduction & recovery of LVF