Background
Anthracycline therapy may induce left ventricle (LV) dysfunction. However, few studies investigated how it may affect the right ventricle (RV).
Purpose
The goal of this study was to assess RV systolic function and biomarkers that may predict early dysfunction in breast cancer patients treated with anthracyclines.
Methods
Twenty-seven women with breast cancer (51.8±8.9 years), underwent CMR prior, and up to 3-times after doxorubicin with matching measurements of biomarkers: high-sensitive troponin T (TnT), creatinine-kinase MB isoenzyme (CK-MB) and C reactive protein (CRP).
Results
Before anthracyclines, all subjects had normal LVEF (69.4±3.6%) and RVEF (55.1±9%) and LV and RV EF correlated significantly (ρ=0.42; p=0.031). At 351–700 days after anthracycline, LVEF and LV mass index declined to 58±6% (P<0.001) and 36±6 g/m2 (P<0.001) (table). RVEF also decreased, reaching 46±8% at 231,4 days after (P<0.001), but lost the correlation with LVEF seen at baseline (r=0.22; P=0.068). RVEF showed strong negative association with serum CK-MB (r=−0.4, p=0.004) and no significant correlation with TnT (r=−0.18, p=0.28) or CRP (r=0.03, p=0.932) (figure). In patients with a peak TnT of >10 pg/ml the change of RVEF overtime was significant (Regression Splines coefficients for RVEF: 1.0, p=0.731–peak TnT ≤10pg/ml; 2.51, p<0.001–peak TnT >10 pg/ml). LVEF was not associated with CK-MB (p=ns).
Baseline and Follow-Up CMR Findings Median days after anthracycline Pre-DOX (79,146] (146,231] (231,350] (350,700] N 27 16 19 14 16 LVEF, % 69.4±3.6 61.1±7.6† 55.99±5.0† 53.8±8.4† 57.5±6.1† LVEDV index, ml/m2 60.2±9.9 64.3±9.6 66.7±17.7 * 56.9±18.5 59.2±12.6 LVESV index, ml/m2 18.3±4.0 24.7±7.3# 29.0±7.3† 26.2±9.7† 25.3±8.2† LV mass index, g/m2 51.4±8.0 45.3±3.8† 43.2±4.9† 39.9±5.4† 36.0±6.1† RVEF, % 55.1±9.4 51±8.1 48±8.5 46±8.5 50±7.4 RVEDV index, ml/m2 45.07±6.6 46.5±11.31 47.35±9.16 41.14±9.7 46.16±7.3 RVESV index, ml/m2 20.45±5.4 22.31±5.8 24.77±6.6 21.96±6.4 22.24±4.7 Data are presented as mean ± SD. LV: left ventricle; RV: right ventricle; EF: ejection fraction; EDV: end diastolic volume; ESV: end systolic volume (average±SD). *Significantly different from Pre-DOX level (p<0.05 from linear mixed effects model). #Significantly different from Pre-DOX level (p<0.01 from linear mixed effects model). †Significantly different from Pre-DOX level (p<0.001 from linear mixed effects model).
RVEF and correlate variables
Conclusions
RVEF reduction does not follow LVEF changes after anthracyclines and CK-MB may be a more specific biomarker to assess RV dysfunction. A higher peak cTnT could predict a greater change in RVEF during follow-up.