Right heart function deteriorates in breast cancer patients undergoing anthracycline-based chemotherapy

Boczar, Kevin E.; Aseyev, Olexiy; Sulpher, Jeffrey; Johnson, Christopher; Burwash, Ian G.; Turek, Michèle; Dent, Susan; Dwivedi, Girish

doi:10.1530/erp-16-0020

Cited by 46 publications

(32 citation statements)

References 28 publications

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“…More recently, a published study including 49 breast cancer patients undergoing anthracycline‐based chemotherapy reported that mean RV fractional area change (FAC), the important parameter of RV radial systolic function, decreased significantly from 48.3% to 42.1% ( P = 0.01) during a period of 3 months . Similar results were reported by Calleja et al, who followed 40 female patients with breast cancer treated with trastuzumab with or without anthracycline .…”

Section: Chemotherapy‐induced Rv Remodelingsupporting

confidence: 86%

“…Boczar et al used echocardiographic methods to follow 49 patients with breast cancer treated with anthracycline‐based chemotherapy and revealed significant worsening of RV longitudinal strain 3 months after therapy initiation (from −16.2% to −13.81%, P = 0.04) …”

Section: Chemotherapy‐induced Rv Remodelingmentioning

confidence: 99%

“…The data about the influence of chemotherapy on right ventricular (RV) function and mechanics are scarce and conflicting . However, the number of studies that underline the predictive significance of RV structure, function, and deformation in patients with different cardiovascular conditions is constantly increasing …”

Section: Introductionmentioning

confidence: 99%

“…7,8 The data about the influence of chemotherapy on right ventricular (RV) function and mechanics are scarce and conflicting. [9][10][11][12] However, the number of studies that underline the predictive significance of RV structure, function, and deformation in patients with different cardiovascular conditions is constantly increasing. [13][14][15] The aim of this review was to summarize the current knowledge about the impact of chemotherapeutic agents on RV remodeling from potential mechanisms to diagnostics.…”

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confidence: 99%

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The influence of chemotherapy on the right ventricle: did we forget something?

Tadić

Cuspidi

Hering

et al. 2017

Clinical Cardiology

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Background A large number of chemotherapy‐induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy‐induced right ventricular (RV) remodeling and summarize clinical studies on this topic. Hypothesis Chemotherapy induces RV structural, functional, and mechanical changes. Methods We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword “chemotherapy,” “heart,” “right ventricle,” “anthracyclines,” and “trastuzumab.” Results The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy‐induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment. Conclusions Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.

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Section: Chemotherapy‐induced Rv Remodelingsupporting

confidence: 86%

Section: Chemotherapy‐induced Rv Remodelingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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The influence of chemotherapy on the right ventricle: did we forget something?

Tadić

Cuspidi

Hering

et al. 2017

Clinical Cardiology

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“…They supposed that the right ventricle has a larger volume and so, less mass and it works against lower afterload [17]. Boczar et al [18] studied RV in breast cancer patients who received anthracyclin, and they hypothesized that a thinner RV may be more sensitive to the toxicity of chemotherapy compared to the thicker LV but there are no other supportive data.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular 2D speckle-tracking echocardiography in children with osteosarcoma under chemotherapy

et al. 2019

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BackgroundCardiotoxicity from anthracyclin chemotherapy is a leading cause of death in patients with cancer. Therefore, left ventricular (LV) function is routinely assessed during protocol to detect cardiotoxicity; however, animal studies suggest that right ventricular (RV) function may be also impaired. So, our objective was to investigate the incidence of RV dysfunction in children with osteosarcoma receiving anthracyclines and to highlight the role of 2D STE in early detection of RV dysfunction.ResultsRV function was affected by anthacyclines through direct cardiotoxic effect on RV myocardium without simultaneous derangement of LV function. Furthermore, there is a direct proportion between the incidence of RV dysfunction and the cumulative dose of anthracyclines. At the first echo follow-up at 10th week, 7 patients had impaired RV GLS in comparison to baseline study. At 20th week, the number of patients with impaired RV strain increased to 10. At 29th week, it reaches 12 patients. This effect was early detected by RV 2DSTE before adversely affecting TAPSE and FAC. The incidence of RV dysfunction from anthracyclines was around 12%, and the recovery rate was around 8% in 3 months after completion of chemotherapy.ConclusionRV 2DSTE is the best modality to detect early affection of RV function in comparison with other modalities. RV function decreases early even before derangement of LV function. Accordingly, it should be assessed separately in all patients who received anthracyclines even without evident LV affection.

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