Background: Cancer therapy– related cardiac dysfunction (CTRCD) is nowadays a frequently encountered clinical presentation, and transthoracic echocardiography (TTE) is usually the routine imaging modality of its screening and detection. The aim is to early detect subclinical CTRCD using non invasive imaging techniques & cardiac biomarkers. Methods: Eighty-eight patients with cancer, planned to receive Anthracyclines(AC) or Trastuzumab (TZB) were enrolled, baseline screening included 2D TTE, GLS and cardiac troponin I and NtProBNP measurments before receiving any treatment, follow up at three and six months were done using the same variables to early detect CTRCD and start CPT even in cases of mild dysfunction. Results: Twenty six patients developed CTRCD, 18 had mild and 8 had moderate asymptomatic CTRCD defined by relative decline in GLS & LVEF following the latest ESC cardio-oncology guidelines. The percentage of change in GLS from baseline and at 3 and 6 months was able to detect CTRCD in both groups in our population which was >16.6% at 3 months with P value of <0.001*and CI 0.783 – 0.934 and >10.10% at 6 months with P value of of <0.001*and CI 0.765 – 0.935 .At three months GLS values ≤-18.6 was able to detect CTRCD with P value of of <0.001*and CI 0.673 0.885.Compared to patients who did not develop CRTD, patients with mild asymptomatic CTRCD had double levels of NT-Pro BNP with a median of (99.5 ) ( IQR: 44.0 – 154.0) at 3 months follow up with P value 0.037 which was normalized at 6 months. Conclusion: The relative decline of GLS and elevation of NT-proBNP were able to diagnose patients with subclinical CTRCD in patients receiving AC with early start of Cardioprotective Treatments (CPT) which enabled the patients to continue their chemotherapeutic treatment uninterrupted without developing serious grades of LV dysfunction and even some patients showed improvement after CPT.

Aims LA functions assessment using 2D speckle tracking echocardiography and 3D transthoracic echocardiography in moderate-severe mitral valve stenosis in comparison to normal subjects. Methods and results Fifty patients and 50 controls were studied. Patients’ mean age was 40.2 ±8.8 years, the majority were female 45(81.8%), the mean body surface area was 1.81 ± 0.16 m2. 3D LA maximum (LAVmaxI) and minimum (LAVminI) volumes indexed to BSA were both significantly higher in MS than in control group, whereas 3D LA EF was significantly lower in MS than in control group, both with p 0.001.LA strain reservoir, conduit, and contraction parameters were significantly lower in the MS group than in control group (p =0.001). All LA assessment parameters (3D LAVmaxI, 3D LAVminI, 3D LAEF, 2D LASr, 2D LAScd, 2D LASct, 2D LAD, 2D LAVI) correlated with each other (p <0.01). However, only 3D LAEF, 2D LASr, 2D LAScd, and 2D LASct showed correlation with the mitral valve area with p <0.05, but 3D LAVmaxI and 3D LAVminI did not. Additionally, in comparison of moderate and severe MS subgroups, 3D LAVmaxI and 3D LAVminI did not show any statistically significant differences between the two groups, although 3D LAEF, 2D LASr, 2D LAScd, and 3D LASct showed significant difference between the two group( p<0.05). Conclusions Comprehensive LA assessment is of clinical significance for its predictive and prognostic value in mitral stenosis. In addition, LA function assessment by 3D echocardiography and 2D speckle tracking echocardiography correlate better with MS severity than conventional LA size parameters.