Alterations in the echocardiographic variables of the right ventricle in asymptomatic patients with breast cancer during anthracycline chemotherapy

Esfahani, Morteza Abdar; Mokarian, Fariborz; Karimipanah, Mohammad

doi:10.1136/postgradmedj-2016-134286

Cited by 14 publications

(13 citation statements)

References 24 publications

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“…our study, 3D GLS of LV and RV decreased significantly at the end of anthracycline chemotherapy and 12 months after chemotherapy. Several studies 20,22,23 evaluated the prognosis of RVEF, RV FAC, TAPSE, and tricuspid annular S′ in patients receiving anthracycline treatment for breast cancer. Data on RV systolic function are discordant.…”

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confidence: 99%

Assessment of Subclinical Deterioration of Right Ventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Xu¹,

Mao²,

Liu³

et al. 2021

IJGM

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Objective: This study was aimed at assessing the longitudinal strain changes of RV function using three-dimensional speckle tracking echocardiography (3D STE) in breast cancer patients receiving anthracycline chemotherapy. Patients and Methods: A total of 95 women with breast cancer receiving epirubicin (360 mg/m 2) underwent 3D STE at baseline, the end of chemotherapy and 12 months after chemotherapy. 3D STE assessment included RV ejection fraction (EF), LV global longitudinal strain (GLS), RV GLS, and RV free wall longitudinal strain (RV FWLS). Meanwhile, serum hs-cTnI and NT-proBNP were measured. Chemotherapy-related cardiac dysfunction (CTRCD) was defined as an absolute decrease in 3D LVEF > 10% to a value <50%, while a percent reduction of 3D LV GLS > 15% indicated subclinical CTRCD. Results: Subclinical CTRCD occurred in 10 (10.5%) patients during follow-up. Compared to baseline, the 3D GLS of LV and GLS and FWLS of RV decreased significantly at 12months after chemotherapy (all p<0.01). Variations of 3D RV GLS and RV FWLS had a good discrimination for predicting subclinical CTRCD. The variation of 3D RV FWLS was the only independent predictor of subclinical CTRCD (OR, 1.37; 95% CI, 1.12-2.87; p = 0.028) in multivariate analysis. The cutoff value with −17.5% of 3D RV FWLS variation had a high predictive accuracy for subclinical CTRCD, with an AUC of 0.74, 80.5% sensitivity and 65.8% specificity. The association between 3D RV FWLS and the cumulative dose of anthracyclines was calculated by Spearman's test (r = −0.71, p < 0.001). Conclusion: Longitudinal strain analysis by 3D STE allows the identification of subclinical RV dysfunction when conventional indices of RV function are unaffected. 3D RV FWLS was superior to other parameters in early detection of the development of CTRCD in breast cancer patients receiving epirubicin therapy.

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confidence: 99%

Assessment of Subclinical Deterioration of Right Ventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Xu¹,

Mao²,

Liu³

et al. 2021

IJGM

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“…There has been significant interest in early detection of cardiotoxicity from chemotherapy. A recent study examined echocardiographic variables including RV end‐diastolic volume, RVFAC, and TAPSE in patients receiving anthracycline treatment for breast cancer . TAPSE and RVFAC decreased significant prior to any detectable changes in the RA size and LV size and function.…”

Section: Current Evaluation Of the Rv In Selected Diseasesmentioning

confidence: 99%

Echocardiographic evaluation of the right ventricle: Clinical implications

Dutta

Aronow

2017

Clinical Cardiology

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Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S 0 , and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV. | ANATOMY OF THE RVThe RV is composed of 3 different segments: the inlet area, the trabecular portion, and the outflow area. The inlet extends from the papillary muscles to the tricuspid annulus. The trabecular portion extends from the papillary muscles to the right ventricular (RV) apex.The outflow portion is a smooth area leading to the pulmonic valve. 1Because the RV does not follow a traditional symmetrical shape, the RV volume does not lend itself to estimation. Wall-motion abnormalities are also more difficult to evaluate, as there are 3 different subsections. Wall motion is also difficult to evaluate due to a combination of radial, longitudinal, and circumferential shortening; these independent movements are not clearly visible on an echocardiogram. 2Normal values for the RV were significantly limited due to the lack of standardization across echocardiographic protocols. cMRI, which measures the RV in planes that are not visualized on echocardiography, was able to provide a series of normal valves. As a result, we know that although RV mass and volumes are larger among males vs females, there is no significant difference in systolic function. | FUNCTION OF THE RVThe LV is often described as a pump whose function is based on its inherent contractility. In contrast, the RV is profoundly affected by loading conditions. The RV function is dependent on preload and afterload.2 It provides the same stroke volume as the LV with

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“…11,23 Echocardiography can also be used to assess other parameters of myocardial function, which have not been included in current recommendations and which may be important in predicting the subclinical cardiotoxicity of radiotherapy and chemotherapy. [143][144][145][146][147][148] Changes in left ventricular diastolic function parameters, including mitral inflow wave velocity, E/A ratio, pulmonary vein flow, isovolumetric diastolic time, or tissue Doppler velocity, can be observed in patients undergoing oncological treatment a few hours after chemotherapy. 143 A significant decrease in right ventricular systolic and diastolic function and changes in the volume and function of the left atrium in treated oncological patients are also considered as an early marker of CTRCD.…”

Section: Imaging Tests Echocardiographymentioning

confidence: 99%

“…143 A significant decrease in right ventricular systolic and diastolic function and changes in the volume and function of the left atrium in treated oncological patients are also considered as an early marker of CTRCD. 143,145,146,148 Studies and results presenting promising parameters of significant importance in the assessment of oncological treatment related complications are summarized in Table 3. [136][137][138][139][140][141][142][143][144][145][146][147][148]…”

Section: Imaging Tests Echocardiographymentioning

confidence: 99%

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Adjuvant breast cancer treatments cardiotoxicity and modern methods of detection and prevention of cardiac complications

et al. 2021

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The most common cancer diagnosis in female population is breast cancer, which affects every year about 2.0 million women worldwide. In recent years, significant progress has been made in oncological therapy, in systemic treatment, and in radiotherapy of breast cancer. Unfortunately, the improvement in the effectiveness of oncological treatment and prolonging patients' life span is associated with more frequent occurrence of organ complications, which are side effects of this treatment. Current recommendations suggest a periodic monitoring of the cardiovascular system in course of oncological treatment. The monitoring includes the assessment of occurrence of risk factors for cardiovascular diseases in combination with the evaluation of the left ventricular systolic function using echocardiography and electrocardiography as well as with the analysis of the concentration of cardiac biomarkers. The aim of this review was critical assessment of the breast cancer therapy cardiotoxicity and the analysis of methods its detections. The new cardio-specific biomarkers in serum, the development of modern imaging techniques (Global Longitudinal Strain and Three-Dimensional Left Ventricular Ejection Fraction) and genotyping, and especially their combined use, may become a useful tool for identifying patients at risk of developing cardiotoxicity, who require further cardiovascular monitoring or cardioprotective therapy.

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Alterations in the echocardiographic variables of the right ventricle in asymptomatic patients with breast cancer during anthracycline chemotherapy

Abstract: This study shows a significant decrease in RV systolic and diastolic function during chemotherapy for 6 months. These reductions are in the normal range and can probably be considered an early indicator of anthracycline-induced cardiotoxicity.

Cited by 14 publications

References 24 publications

Assessment of Subclinical Deterioration of Right Ventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Assessment of Subclinical Deterioration of Right Ventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Echocardiographic evaluation of the right ventricle: Clinical implications

Adjuvant breast cancer treatments cardiotoxicity and modern methods of detection and prevention of cardiac complications

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