الفهرس 
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Abstract
Anthracyclines Discovery in 1960s was a major breakthrough in the field of oncology. Anthracyclines administration is often accompanied by adverse drug reactions that limit the use of athracyclines in the clinics. Two major dose limiting toxicities of anthracyclines include myelo-suppression and cardiotoxicity. Cardiooncology is a new discipline that focuses on screening, monitoring and treating patients with heart disease during and after cancer treatment. It is a multidisciplinary field that requires oncologists and cardiologists to be brought together to provide short- and long-term cardiovascular (CV) care for cancer patients and survivors. Cardiac dysfunction and heart failure (HF) are well recognized complications that impact the survival and quality of life in cancer patients. Myocardial strain analysis using 2-D speckle tracking imaging is a promising candidate for the detection of early cardiotoxicity.
Two Main Values are obtained from 2-D speckle tracking which are: Longitudinal speckle tracking and Strain rate either systolic or diastolic, Any Decrease of both Values from the cut-point Either Globally or two or more walls, The oncology Department is Informed To decrease the cumulative doses of anthracyclines to maintain it is continuity and protect the patients from Harmful Hazards.
Aim of the study: This study aims to detect early (subclinical) systolic or diastolic cardiac dysfunction in breast cancer patients treated with anthracyclines based control protocol using different conventional echocardiographic methods and speckle tracking Patients and methods: This was a prospective observational study that included Forty patients, age ranges from 25 to 72 years of both sexes who were referred to cardiology department, Menofia University Hospital from December 2021 to February 2023 for transthoracic Echocardiography and/ or Cardiological Consultation before and 4 months after receiving anthracyclines as chemotherapy for treatment of Breast cancer. . The study was approved by the ethics committe of faculty of Medicine, Menofia University. Informed consent was obtained from all the patients who were included in the Study explanation of benefits and risks of the study, and any unexpected risk appearing during the course of the study were cleared to the patients and the ethical committee on time, All privacy issues and Private data were kept confidentially as secrets for the the participants. Two Echocardiographic modes were used:
A. Conventional echocardiography 2D analysis:
All required conventional echocardiographic data will be taken using:
- Apical window (four & five and three chamber views) for: Identification of LV systolic function using Simpson’s method Detection of regional wall motion abnormalities pericardial effusion Detection of Detection of intracardiac masses B. LV two-dimensional speckle tracking echocardiography (2DSTE):
Patients will be selected for acceptable image quality, excluding patients with two or more segments not visualized by conventional 2D echocardiography. The end-diastole and end-systole of the LV apical four-, three- and two-chambers views frames will be identified based on aortic valve closure and electrocardiogram (ECG) trace. Four-, three-, and two- chambers apical LV views for LVGLPS analysis will be recorded, with the adjustment of image contrast, frequency, depth, and sector size for adequate frame rate and optimal LV border visualization. Care will be taken to avoid LV foreshortening, and image acquisition will be done during breath-hold to minimize respiratory movements. Data sets will be digitally stored in images data format and will be exported to a separate work station for offline analysis. Image analysis will be performed off-line using customized software with in the echo PAC workstation (GE health care). The endocardial boundary will be traced manually, using an interrupted mouse clicks technique and tracked throughout the cardiac cycle based on an automated STE algorithm, LVGLS and strain rate (systoilc,early daistolic,late diastoilc) will be automatically calculated by the software for both baseline and follow up studies, after the automatic calculation by the software, Multiple results will be obtained for the study to Detect the subclinical cardiotoxicity for (18 segment) of the myocardium.