BACKGROUND: Physical exercise adds benefits improving evolution of the ischemic heart disease, enhancing individual functional capacity and preventing ventricular remodeling. In this study we investigated the impact of a program of physical training started after an uncomplicated post-acute myocardial infarction (AMI) on the mechanics of left ventricle (LV) contraction. METHODS: A total of 53 patients were included, 27 of whom were randomized to a supervised training program (TRAINING group), and 26 to a CONTROL group, who received usual orientations for physical exercise after AMI. All patients underwent cardiopulmonary stress testing and an echocardiogram with speckle tracking technique to measure several parameters of LV contraction mechanics at 1 month and 5 months after AMI. RESULTS: No significant difference in the analysis of LV longitudinal, radial and circumferential strain parameters between groups after the training period was found. After the training program, analysis of torsional mechanics demonstrated a reduction in the LV basal rotation of the TRAINING group in comparison to the CONTROL group (TRAINING, -5.9±2.3 vs CONTROL, -7.5±2.9 o; P=0.03), and in the basal rotational velocity ​​( TRAINING, -53.6±18.4 vs CONTROL, -68.8±22.1 º/s; P=0.01), twist velocity (TRAINING, 127.4±32.2 vs CONTROL, 149.9±35.9 vs º/s; P=0.02) and torsion (TRAINING, 2.4±0.4 vs CONTROL, 2.8±0.8 vs º/cm; P=0.02). CONCLUSIONS: Physical activity did not cause a significant improvement in LV longitudinal, radial and circumferential deformation parameters. However, the exercise had a significant impact on the LV torsional mechanics, composed particularly of a reduction in basal rotation, twist velocity, torsion and torsional velocity which can be interpreted as a ventricular “torsion reserve” in this population.

Background: Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing this complication. Left ventricle global longitudinal strain (LV-GLS) has been described as a sensitive parameter for detecting systolic dysfunction, even in the presence of preserved left ventricle ejection fraction (LVEF). Objective: to evaluate the role of the LV-GLS as a predictor of ChC. Methods: This study is a post-hoc analysis of CECCY trial (Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity) that evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population with breast cancer. Cardiotoxicity was defined as a reduction >10% in LVEF. LV-GLS was obtained before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results: Thirty-one patients who had a complete echocardiography study including measurement of LV-GLS before chemotherapy were included in this analysis. An absolute LV-GLS <16.9% before chemotherapy showed 100% sensitivity and 73% specificity for predicting cardiotoxicity (AUC=0.85; 95%CI 0.680 – 0.959, p<0.001). In this population, LVEF values before chemotherapy did not predict ChC (95%CI 0.478 to -0.842, p=0.17). The association of low LV-GLS (<17%) and BNP serum levels (>17 pg/mL) two months after chemotherapy increased the accuracy for detecting early onset ChC (100% sensitivity, 88% specificity, AUC=0.94; 95%CI 0.781 – 0.995, p<0.0001). Conclusions: Our data suggest that LV-GLS is a potential predictor of chemotherapy-induced cardiotoxicity. Larger studies are needed to confirm the relevance of this echocardiographic parameter in this clinical setting.