Background Chemotherapeutic drugs may cause many complications affecting the cardiovascular system. There is a strong evidence suggesting the impact of this drugs on the left ventricle (LV), whereas less data regarding cardiotoxicity on the right ventricle (RV) exist. Purpose The aim of this study was to intercept early subclinical RV changes in patients treated with anthracyclines, using advanced echocardiography, with the hope that these could potentially be used to predict ventricular dysfunction. Methods In our single-center study, 20 female patients with breast cancer treated with anthracyclines were enrolled from 2019 to 2021. Cardiological evaluation and echocardiogram were performed at baseline (T0), 3 months (T1) and 6 months (T2) after initiation of chemotherapy. RV systolic function was calculated by estimation of conventional 2D echocardiographic and Doppler parameters (TAPSE, S’RV, FAC). Advanced echocardiography evaluation of right ventricular function was performed to quantify the following parameters: 3D right ventricular end-diastolic volume (RVEDV), 3D end-systolic volume (RVESV), 3D stroke volume (RVSV), 3D ejection fraction (RVEF), global longitudinal strain of the RV (RVGLS) and longitudinal free wall strain of the RV (RVLFS). Results Only 2 patients developed cardiotoxicity according to the criteria of the 2022 ESC Guidelines. Regarding the impact of chemotherapy on RV function, no statistically significant changes were found in conventional echocardiographic parameters (TAPSE, S’RV, FAC). In contrast, speckle tracking analysis of the RV showed a statistically significant reduction in both global strain [global RVGLS -23.3 ± 2.2% at T0 vs -19.5 ± 10.9% at T1 (p<0.0001); global RVGLS -23.3 ± 2.2% at T0 vs -19.8 ± 3.2% at T2 (p<0.0001)] and free wall strain [RVLFS -30.02 ± 3.3% at T0 vs -18.2 ± 21.2% at T1 (p=0.0001); RVLFS -30.02 ± 3.3% at T0 vs -23.7 ± 4.6% at T2 (p=0.0006)]. We observed a statistically significant increase in RVEDV at T1 compared to baseline [3D RVEDV 81.3 ± 16,9 ml al T0 vs 82.6 ± 19.2 ml at T1 (p=0,04)], whereas there were no significant changes at T2. Estimation of RVESV revealed the same trend, with a statistically significant increase in this parameter at T1 compared to baseline [3D RVESV 34.4 ± 10.4 ml at T0 vs 37.8 ± 10.8 ml at T1 (p=0.01)]. In relation to the RVEF, a minimal statistically significant reduction was observed at both T1 and T2 compared to T0 [3D RVEF 63.7 ± 4.3% at T0 vs 62.7 ± 4% at T1 (p= 0.01); 3D RVEF 63.7 ± 4.3% at T0 vs 58.7 ± 6% at T2 (p= 0.02)]. Conclusions RV speckle tracking and 3D echocardiography seemed to intercept subclinical damage due to anthracyclines earlier than conventional parameters. Further studies are needed to confirm our results and to evaluate their prognostic impact.
Background The aim of our study was to assess subclinical cardiac effects of anthracyclines (ANTs) in women treated for breast cancer (BC). Methods We enrolled 46 female patients with BC undergoing adjuvant treatment with anthracycline–containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel). Patients underwent physical examination, electrocardiogram (ECG) and standard transthoracic echocardiography (TTE) including evaluation of diastolic and systolic function, measured as left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS) and myocardial work (MW) expressed as global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE). The parameters were measured at baseline (T0) and at 3 months (T1) and 6 months (T2) follow up. Results All patients completed the chemotherapy cycles. No significant cardiovascular adverse events were observed during treatment. Neither 2D left ventricular ejection fraction (LVEF) nor E/e’ ratio evaluation at TDI were significantly changed after treatment. Conversely, GLS was significantly reduced at T1 and T2 since baseline (GLS – 19,99 % IQR –20,6 –19,3 % at T0 vs –17,88 % IQR –18,8 –16,9 % at T1, p < 0,00 1 and –16,71 % IQR 17,6 –15,7 % at T2, p < 0,001). Consensually, a significant reduction in myocardial work was also measured (GWI 2115 mmHg% IQR 1888 – 2342 mmHg% at T0 vs 1714 mmHg% IQR 1557 – 1870 mmHg% at T1, p < 0,0001 and 1694 mmHg% IQR 1482 – 1907 mmHg% at T2, p < 0,0001). Conclusion Our study demonstrates that evaluation of myocardial work allows very early detection of subclinical cardiac damage induced by chemotherapy, consensually to the reduction of the GLS. A multiparametric assessment of the myocardial function, including myocardial work and GLS, could improve the accuracy of risk stratification of cardiotoxicity in patients undergoing ANTs treatment.
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