Early Detection and Prediction of Anthracycline-Induced Right Ventricular Cardiotoxicity by 3-Dimensional Echocardiography

Zhao, Rui; Fang, Shu; Zhang, Chujie; Song, Feiyan; Xu, Yuchen; Guo, Ye; Xue, Kai; Lin, Jing; Shu, Xianhong; Hsi, David H.; Cheng, Leilei

doi:10.1016/j.jaccao.2020.01.007

Cited by 53 publications

(57 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To our knowledge, our study is one of the first of its kind to show that subclinical RV dysfunction parameters were associated with higher cumulative doses of doxorubicin even though LVEF was not. Zhao et al recently demonstrated subclinical changes in RV function parameters after 6 cycles of anthracycline chemotherapy [11]. Furthermore, our study is the first to assess RV FAC as a significant measure of RV function in this setting.…”

Section: Discussionmentioning

confidence: 57%

Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

et al. 2020

View full text Add to dashboard Cite

Background: Doxorubicin remains one of the most common causes of cardiotoxicity in patients with lymphoma, leading to significant morbidity and mortality. Early decline in left ventricular (LV) ejection fraction predicts chemotherapy-induced cardiotoxicity and mortality, but limited data exist on doxorubicin-induced subclinical right ventricular (RV) dysfunction. We investigated dose-dependent subclinical doxorubicin-induced RV dysfunction in lymphoma patients. Methods: Thirty-five patients with adult lymphoma treated with doxorubicin were studied. All patients had normal baseline LV ejection fraction (LVEF > 55%), and no known cardiopulmonary disease. We studied the dosedependent effect of doxorubicin on RV strain by 2D speckle-tracking echocardiography (STE) using a vendorindependent software (TomTec). Images were analyzed offline by two independent observers blinded to the clinical characteristics of the study population. Baseline LVEF, RV fractional area change (RV FAC), RV free wall strain (RV FWS), and RV global longitudinal strain (RV GLS) were measured prior to chemotherapy initiation and compared with echo studies obtained at a 6-month follow-up interval. Patients served as their own controls. Comparisons between pre-and post-therapy were achieved using paired Student's t-tests or Chi-Square test. Results: The Interobserver Intraclass Correlation Coefficient for RV GLS, RV FAC and RV FWS, was 0.87, 0.81 and 0.79, respectively. The mean age was 51 ± 13 years, 40% women, 60% white. The mean cumulative doxorubicin dose was 239 ± 104 mg m − 2. There was there was significant decline in RV FAC (47.3 ± 4.4% vs. 43.7 ± 3.9%), RV FWS (− 24.9 ± 3.3 vs.-22.2 ± 2.9), and RV GLS (− 22.4 ± 4.1 vs.-20.6 ± 3.4) (all p < 0.01); but no significant decline in LVEF during the 6-month follow up (63.3 ± 6.2% vs. 61.6 ± 11.1%, p = 0.374). At cumulative doxorubicin dose ≥200 mg m − 2 we found a significant decline in RV FAC (47.0 ± 4.7% vs. 42.2 ± 3.1%, p < 0.01), RV FWS (− 24.6 ± 3.6 vs.-21.5 ± 2.4, p < 0.01), and RV GLS (− 22.3 ± 4.5 vs.-20.1 ± 2.9, p = 0.03). Conclusion: In this cohort of adult lymphoma patients, doxorubicin-based therapy was associated with subclinical RV dysfunction, but not LV dysfunction, at a cumulative dose ≥200 mg m − 2. Additional studies evaluating the longterm prognostic implications of RV dysfunction in this population are essential.

show abstract

Section: Discussionmentioning

confidence: 57%

Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Right ventricular dysfunction upon cancer therapy is more common in cancer survivors than LV dysfunction and develops 6-7.5 months after exposure to anthracyclines and/or trastuzumab with a dose-dependent incidence [31]. Threedimensional assessment of RV volumes including the assessment of RV strain may represent a beneficial tool for the evaluation of chemotherapy-related RV dysfunction and has yielded consistent results, but it is not yet broadly applied in standardized echocardiographic examinations [32]. Future studies are needed to determine appropriate cutoff values and recommendations for the use in oncocardiology [31].…”

Section: New Imaging In Oncocardiologymentioning

confidence: 99%

Oncocardiology: new challenges, new opportunities

Michel

Schadendorf

Rassaf

2020

Herz

View full text Add to dashboard Cite

“…Recent studies emerging in parallel in the pandemic and in cardio-oncology indicate that the RV may play an important role in the prognosis of patients with COVID-19 or CVT from cancer therapy; RV failure generally associates with worse outcomes in a variety of populations, and patients with COVID-19 or CVT from cancer therapies may be no different (35)(36)(37)(38). While the mechanisms of insult to the RV in COVID-19 are different from those in cardio-oncology, similar changes are noted in the ventricle and these may have prognostic value.…”

Section: Emerging Role Of Right Ventricular Failurementioning

confidence: 99%

“…While the mechanisms of insult to the RV in COVID-19 are different from those in cardio-oncology, similar changes are noted in the ventricle and these may have prognostic value. Importantly, RV longitudinal strain (RVLS) has emerged as a key player in the prediction of RV failure in both COVID-19 and cardio-oncology (36,38).…”

Section: Emerging Role Of Right Ventricular Failurementioning

confidence: 99%

“…In cardio-oncology, changes are also noted in RV strain, structure, function, and size in patients with breast cancer and lymphoma who receive anthracycline chemotherapy (36,51). Although the left ventricle is more commonly studied, the RV also shows impairment in contractility, with temporal changes of decreased RVLS and increased right ventricular end systolic volume (RVESV) preceding reduction in right ventricular ejection fraction (RVEF) (36). Additionally, patients with end-stage heart failure as a result of cardiomyopathy from anthracycline therapy benefit from RV assist device support (52).…”

Section: Emerging Role Of Right Ventricular Failurementioning

confidence: 99%

See 1 more Smart Citation

Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology

Brown

Zaharova

Mason

et al. 2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.

show abstract

Early Detection and Prediction of Anthracycline-Induced Right Ventricular Cardiotoxicity by 3-Dimensional Echocardiography

Cited by 53 publications

References 25 publications

Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

Oncocardiology: new challenges, new opportunities

Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology

Contact Info

Product

Resources

About