In a retrospective study of patients undergoing cancer therapy, global circumferential strain declined in parallel with global longitudinal strain among patients who developed mild cancer therapy–related cardiac dysfunction, showing moderate correlation and high concordance with global longitudinal strain–defined dysfunction.
The abstract (SIA-04), presented by Nathan Lawson, of Central Sydney Cardiology, Newtown, Australia, at the American Society of Echocardiography (ASE) 2026 Scientific Sessions and published in the Journal of the American Society of Echocardiography, received the 2026 Brian Haluska Sonographer Research Award.
“These findings support the potential utility of GCS [global circumferential strain] as an alternative or complementary tool for identifying subclinical CTRCD [cancer therapy–related cardiac dysfunction] in patients undergoing cancer therapy, particularly when GLS [global longitudinal strain] assessment is limited by suboptimal apical windows,” the researchers wrote in the abstract.
Unlike GLS, GCS can be measured from parasternal windows.
Study Details
The single-center study included 78 patients undergoing cancer therapy who had at least 2 echocardiographic examinations available. Eligible patients had normal baseline left ventricular ejection fraction (LVEF) and GLS values, as well as adequate image quality for GCS assessment. Those with moderate or greater CTRCD were excluded.
The researchers compared changes in GCS and GLS between 38 patients who developed mild CTRCD, defined as a greater than 15% relative reduction in GLS, and 40 patients who did not. Because mild CTRCD was defined by relative GLS reduction, the findings show concordance with a GLS-based definition rather than independent validation against clinical outcomes.
Key Findings
There were no statistically significant differences observed in mean baseline LVEF (56% vs 58%), GLS (both −19%), or GCS (both −21%) between patients who did and did not develop CTRCD.
Mean relative change in GCS was similar to GLS in both groups: −19% for both measures among patients with CTRCD and −5% vs −4%, respectively, among those without CTRCD. LVEF remained within the normal range in both groups, with no clinically significant changes observed. The researchers reported moderate correlations between GCS and GLS in both groups.
Relative reductions of greater than 15% in GCS and GLS were concordant in 92% of patients with CTRCD and 93% of those without CTRCD.
Clinical Implications
In an exclusive interview with Conexiant, when asked what he hopes clinicians will take away from the findings, Lawson emphasized that GCS should not be overlooked.
“I know there’s a lot of focus in cardio-oncology on GLS…, and rightly so. There’s a lot of validated research behind it, but I think GCS could be a potential alternative, or at least a complementary piece of the puzzle.”
During his presentation, Lawson said GCS may be more feasible and reproducible in patients with breast implants, prior surgery, or generally challenging acoustic windows.
However, “at least at the start,” Lawson told Conexiant, patients with breast cancer may benefit most from this approach. He said this observation prompted the analysis: “As we saw more and more cardio-oncology patients, we saw a lot of [patients with] breast cancer. As we saw more and more [patients with] breast cancer, we saw more who had breast implantation or postmastectomy scarring. In those patients, it can be difficult to monitor left ventricular function from the apical windows.”
Lawson said more prospective studies are needed to establish the clinical utility of GCS. Because the measurement is not routinely performed in many echocardiography laboratories, he noted that widespread implementation would require training for both sonographers and physicians. He added that prospective studies are needed to validate clinically significant cutoff values for use in cardio-oncology surveillance.
Lawson declared no relevant conflicts of interest.
Source: ASE 2026 Scientific Sessions / Journal of the American Society of Echocardiography
