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

Abstract

Background Despite the cardiotoxic effect of anthracycline on the left ventricle (LV) was wholly identified. the assessement of anthracycline effect on the right ventricle(RV) by conventional echocardiography was achallenge due to its complex geometry. our study was to evaluate the impact of anthracycline on the RV volume and function using 3D –echocardiography (3DE) and 2D -speckle tracking echocardiography (2D-STE) in patients with breast cancer. Methods The study was conducted on 66 female patients with breast cancer receiving anthracycline chemotherapy, in addition to full echocardiography, 2D-STE and 3DE evaluation of RV function and volume were done at baseline, after 4th cycle of chemotherapy, six and nine months after the end of chemotherapy. Results Cardiotoxicity from anthracycline occurred in18 patients whose LVEF became significantly reduced after 9 months of therapy according to that, the patients were divided into the non-cardiotoxic group (n:48) and the cardiotoxic group (n:18). At cardiotoxic group, 3D RVESV and 3D RVEDD increased significantly at 6 months and continued till 9 months compared to baseline values (42.50 ± 5.98 vs 50.44 ± 7.01, p = 0.005) and (86.78 ± 9.16 vs 95.78 ± 9.23, p = 0.021) .LVGLS showed a significant reduction early after 6 months of therapy, 2D GLS and FWLS of RV were significantly decreased at 6 months and continued till 9 months after therapy (-22.54 ± 0.79 vs. -19.53 ± 1.32, p = 0.001) and (-24.67 ± 1.27vs. -22.22 ± 1.41, p = 0.001) respectively. The variation of RVFWLS was a predictor of cardiotoxicity, the relative drop of RVFWLS 19.3% had 83% sensitivity and 71% specificity, (AUC = 0.82) to identify patients developed cardiotoxicity Conclusion 3DE is a promising modality in recognizing the early changes in RV volumes and minute alteration in RV function and 2D-STE is a reliable predictor of RV systolic dysfunction which identify the subclinical affection.

Right ventricular dysfunction in cancer patients; Is it real or dilemma? A narrative review

“…Checking RV function using RV GLS and RV FWLS is more accurate than other echocardiography methods. 3D echocardiography has been a great development for cardiovascular examinations, including the examination of the function and structure of the right ventricle [10,[12][13][14][15][16][17][18][19][20][21][22][23]. Considering the specific anatomy of the RV, CMR is an accurate diagnostic method to check the function of the RV, but in many centers its cost is high and it is not covered by insurance, so its use is not possible for everyone [24][25][26][27][28][29].…”

“…In most of the studies, following chemotherapy, RV function reduction occurred. The first reduction in RV GLS and RV FWLS and then a reduction in RVEF occurred [15][16][17]19,[21][22][23]. According to the results of some studies, RV toxicity may occur with a lower dose of anthracycline than LV toxicity [13,32].…”

“…study, following chemotherapy, the emergence of abnormal RV GLS was linked to overt heart failure, a rise in all-cause mortality, and a higher rate of cardiovascular death [22]. 2D STE is a reliable predictor of RV systolic dysfunction, which identify the subclinical affection, and 3D echocardiography is a promising modality in recognizing the early changes in RV volumes and alteration in RV function [23].…”