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

Abstract

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.

Detection Of Right Ventricular dysfunction by Three – Dimensional Echocardiography and Two - Dimensional Speckle Tracking in Breast Cancer Patients Receiving Anthracycline- based Chemotherapy

“…Unlike ours, their study did not detect any signi cant reduction in LVEF after six months of follow-up and concluded that doxorubicin therapy is associated with subclinical RV dysfunction. [28] The study of Xu et al [34] who assessed RV function in 95 women with breast cancer receiving epirubicin therapy, found that 3D GLS of LV and both RV GLS and FWLS were depressed signi cantly at 12 months without the occurrence of cardiotoxic affection of LVEF and RVEF, these variations of 3DRV strain allow the identi cation of subclinical RV dysfunction when conventional parameters unaffected, same as our results.…”

“…Cherata et al [32] who assessed RV systolic function in 68 cancer patients receiving cardiotoxic agents demonstrated that a 17% reduction of RV FWLS had a sensitivity of 55% and a speci city of 70% with an AUC of 0.75 to identify patients with CTRCD Another study reported that the optimal cut-off value of 17.5% of 3D RV FWLS percent changes showed high prognostic accuracy for subclinical cardiac dysfunction, with an AUC of 0.74, a sensitivity of 80.5%, and a speci city of 65.8%. [34] Our study found that the longitudinal strain analysis permits early identi cation of subclinical RV dysfunction when the standard 2D indices of RV function are unaltered. RV FWLS is more accurate than RV GLS in the evaluation of RV systolic function since the intraventricular septum is a constituent part of the LV.…”

“…[27,28] Other studies reported a signi cant change in TAPSE at the end of chemotherapy or during follow-up. [29,30] Rui et al [31] and Cherate et al [32] couldn't detect a change in FAC or TAPSE in consort with subclinical RV deterioration at the end of chemotherapy even though, Tanindi et al [33] and Xu et al [34] showed a signi cant change in both at the end of chemotherapy and after chemotherapy by 12 months respectively. Therefore, the controversy in evaluating RV function by traditional methods leads to diminishing their role in early subclinical RV affection, which is owing to the complex geometry of RV.…”

Cardiovascular Toxicity Induced by Chronic Vincristine Treatment

“…Other authors have also described similar results since they have demonstrated the lack of association between an alteration in cardiac function and treatment with vincristine ( Maraldo et al, 2015 ). This could suggest the existence of subclinical cardiotoxicity after treatment with this antitumor, in the same way that occurs with other chemotherapeutic drugs such as cisplatin or doxorubicin ( Demkow et al, 2011 ; Sandamali et al, 2020 ; Xu et al, 2021 ). It should be noted that, in our study, after chronic treatment with vincristine, we observed a slight, although not significant, elevation in the coronary perfusion pressure that was maintained even after the suspension of treatment.…”

Mechanical property evaluation of the right ventricular myocardium in cancer patients with chemotherapy by echocardiography: a systematic review and meta-analysis

“…Two hundred and fifty-nine studies were identified from databases and manual search after excluding duplicated studies. Finally, twenty-one trials published between 2013 to 2021, including 1,355 participants, were adopted in our analysis ( 17 - 37 ). The detailed process of literature searching and the explanation for exclusion are described in Figure 1 .…”