Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity

Abstract

Funding Acknowledgements Type of funding sources: None. Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. Abstract Figure.

Effect of Radiotherapy on the Right Ventricular Function in Lung Cancer Patients

“…However, the number of reports on this issue has increased in recent years. Interestingly, early RV dysfunction (reduction of RV GLS) paralleled LV involvement and predicted subsequent LV subclinical dysfunction, as demonstrated in breast cancer patients treated with anthracycline, trastuzumab, and paclitaxel [ 11 ]. Laufer-Perl et al reported that CTR-RVT may be even more frequent than CTR-LVT.…”

HER2-Targeted Therapy—From Pathophysiology to Clinical Manifestation: A Narrative Review

“…No statistically significant alterations were observed in the standard echocardiographic parameters of RV function. The longitudinal strain of the left ventricle also decreased significantly, although to a lesser degree [67]. In a retrospective study, Calleja et al (2015) discovered that the patients (n = 30) with proven TIC had poorer RV function than the control group.…”

“…RV dysfunction is not a starting point for defining cardiotoxic events. After sequential therapy with anthracyclines and trastuzumab, Santoro C. et al (2021) discovered that a significant proportion (66%) of patients experienced decreased longitudinal RV function measured via speckle tracking [67]. No statistically significant alterations were observed in the standard echocardiographic parameters of RV function.…”