Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

Abstract

Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity. Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls. Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%, P = 0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3%) was seen in 40% (n = 12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n = 11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant. Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

The influence of chemotherapy on the right ventricle: did we forget something?

“…Similar results were reported by Calleja et al, who followed 40 female patients with breast cancer treated with trastuzumab with or without anthracycline . RV FAC declined from 47% to 42% ( P = 0.01), whereas pulmonary systolic pressure significantly increased (24 ± 6.4 vs 29 ± 7.5 mm Hg, P = 0.01) …”

“…More recently, a published study including 49 breast cancer patients undergoing anthracycline‐based chemotherapy reported that mean RV fractional area change (FAC), the important parameter of RV radial systolic function, decreased significantly from 48.3% to 42.1% ( P = 0.01) during a period of 3 months . Similar results were reported by Calleja et al, who followed 40 female patients with breast cancer treated with trastuzumab with or without anthracycline . RV FAC declined from 47% to 42% ( P = 0.01), whereas pulmonary systolic pressure significantly increased (24 ± 6.4 vs 29 ± 7.5 mm Hg, P = 0.01) …”

“…10 Similar results were reported by Calleja et al, who followed 40 female patients with breast cancer treated with trastuzumab with or without anthracycline. 11 RV FAC declined from 47% to 42% (P = 0.01), whereas pulmonary systolic pressure significantly increased (24 AE 6.4 vs 29 AE 7.5 mm Hg, P = 0.01). 11 A study by Tanindi et al involved 37 consecutive patients with newly diagnosed breast cancer who received cyclophosphamide + Adriamycin AE 5-fluorouracil.…”

“…The data about the influence of chemotherapy on right ventricular (RV) function and mechanics are scarce and conflicting . However, the number of studies that underline the predictive significance of RV structure, function, and deformation in patients with different cardiovascular conditions is constantly increasing …”

“…7,8 The data about the influence of chemotherapy on right ventricular (RV) function and mechanics are scarce and conflicting. [9][10][11][12] However, the number of studies that underline the predictive significance of RV structure, function, and deformation in patients with different cardiovascular conditions is constantly increasing. [13][14][15] The aim of this review was to summarize the current knowledge about the impact of chemotherapeutic agents on RV remodeling from potential mechanisms to diagnostics.…”