Role of Tei Index in Early Detection of Anthracycline-induced Cardiotoxicity.

BACKGROUND

Although anthracycline chemotherapy is widely used in different types of cancer, they are commonly known to induce cardiotoxicity. Early diagnosis of cardiotoxicity induced by cancer therapy is of great interest. Due to the insensitivity of left ventricular ejection fraction (LVEF) in the early identification of cardiotoxicity, global longitudinal strain (GLS) has become the best approach for early cardiotoxicity identification. The goal of our research was to assess the function of the Tei Index, a relatively new tool for evaluating both diastolic and systolic function, in the prediction of cardiac dysfunction.

MATERIALS AND

METHODS

One hundred patients were enrolled in our prospective observational study. Demographic and clinical data were collected at the first visit. Assessments of LVEF, GLS, and the Tei Index were taken before initiation of therapy and subsequently at 3- and 6-month intervals (2nd and 3rd visit, respectively) following anthracycline.

RESULTS

The patients' mean age was 44.79 ± 14.26 years, predominantly females (76%). The mean LVEF fell from 63.44 ± 3.61 to 59.90 ± 6.00 6 months following chemotherapy. At the 6-month visit, 16% patients developed evident impairment in left ventricular systolic function with LVEF below 55%. The mean GLS at the first visit was 19.94 ± 2.68 and showed a significant decrease in its values to 17.27 ± 2.1 6 months postchemotherapy, with 20% of patients having a percentage change in GLS ≥15% (subclinical cardiotoxicity). Mean Tei Index has been significantly increased from 0.42 ± 0.09 at the first visit to 0.52 ± 0.08 at the third visit. After 6 months postchemotherapy, there was a significant inverse relationship between ejection fraction (EF) and Tei Index (P < 0.001, r = -0.309); on the other hand, there was a notable direct relationship between EF and GLS (P < 0.001, r = -0.438) after 3 months and (P < 0.001, r = -0.583) after 6 months postchemotherapy. Tei Index with cutoff of 0.46 was found to have 100% sensitivity, 57% specificity, and 27.3% positive predictive value (PPV) for the prediction of cardiac dysfunction in comparison to GLS, which had 100% sensitivity, 95 specificity, and 80% PPV.

CONCLUSION

Tei Index is a good negative test for ruling out the cardiac dysfunction, but not for confirming the condition. Keep in mind, follow up should be lasted longer for further assessment of the cardiac dysfunction that may become evident at longer periods. However, our primary purpose was to look for early signs of cardiotoxicity.