Global longitudinal strain (GLS) is a sensitive echocardiographic marker for detecting subclinical myocardial dysfunction. In breast cancer patients undergoing chemotherapy, identifying predictive factors for GLS alteration is crucial for mitigating cardiotoxicity and improving clinical outcomes.

This study aims to assess predictive factors influencing GLS alterations in breast cancer patients treated with chemotherapy, with or without radiotherapy.

A prospective, observational, monocentric study was conducted involving 108 breast cancer patients referred to the cardio-oncology unit of the Military Hospital of Tunis from September 2022 to October 2023. Patients underwent baseline cardiovascular assessments, including echocardiography and GLS measurement, and were stratified into risk groups. GLS alteration was defined as a ≥ 15% reduction from baseline. Clinical, echocardiographic, and treatment-related variables were analyzed using univariate and multivariate approaches to identify predictors of GLS alteration.

Out of 108 patients, 88 completed follow-up. GLS alteration was observed in 42% of patients during the study period. Predictive factors identified in multivariate analysis included a history of anthracycline-based chemotherapy (OR: 9.33, P = 0.042), other chemotherapy regimens (OR: 11.67, P = 0.025), radiotherapy (OR: 2.69, P = 0.049), and baseline cardiovascular risk (OR: 3.36, P = 0.037). Thoracic radiotherapy, particularly left-sided, showed a strong association with GLS reduction ( Fig. 1 ). Cyclophosphamide cumulative dose and epirubicin dose approached statistical significance as predictors ( P = 0.058 and P = 0.087, respectively). Only 28% of patients received cardioprotective treatment, highlighting underutilization of preventive strategies.

This study identifies key predictors of GLS alteration in breast cancer patients treated with chemotherapy and radiotherapy, emphasizing the importance of incorporating GLS monitoring into routine practice. Early risk stratification and timely cardioprotective interventions can reduce the risk of cardiotoxicity and improve outcomes in this high-risk population.