Right ventricular function and mechanics in chemotherapy- and radiotherapy-naïve cancer patients

Abstract

The present research evaluated right ventricular (RV) structure, function and mechanics in the cancer patients before initiation of chemo- or radiotherapy, and the association between cancer and decreased RV longitudinal strain. This retrospective investigation included 101 chemo- and radiotherapy-naïve patients with solid cancer and 38 age- and gender-matched controls with similar cardiovascular risk profile. Echocardiographic examination and strain evaluation was performed in all participants. RV structure and RV systolic and diastolic function estimated with conventional echocardiographic parameters were similar between the cancer patients and controls. However, RV global longitudinal strain (- 22.7 ± 2.6% vs. - 21.1 ± 2.4%, p < 0.001) was significantly decreased in the cancer patients than in controls. The same was revealed for RV free wall endocardial (- 33.6 ± 4.3% vs. - 31.4 ± 4.0%, p = 0.006) and mid-myocardial (- 25.2 ± 3.6% vs. - 23.7 ± 3.8%, p = 0.035) longitudinal RV strains, whereas difference was not found in RV free wall epicardial longitudinal strain. The presence of cancer was independently of age, gender, body mass index, left ventricular hypertrophy, diabetes, hypertension and pulmonary pressure associated with reduced RV global longitudinal strain (OR 3.79; 95% CI 2.18-10.92, p < 0.001), as well as with decreased free wall RV longitudinal strain (OR 5.73; 95% CI 3.17-9.85, p < 0.001). RV strain is deteriorated in the chemo- and radiotherapy-naïve cancer patients. Endocardial and mid-myocardial layers are more affected than epicardial strain in the cancer patients. The presence of cancer is independently of other clinical parameters associated with reduced RV longitudinal strain.

Phasic Left Atrial Function in Cancer Patients Before Initiation of Anti-Cancer Therapy

“…Left ventricular (LV) remodeling in the treated cancer patients has been confirmed in the large number of studies [1,2,3], and particularly important is the incremental predictive value of LV changes in the cancer patients [3]. Our study group recently showed that left and right ventricular functional impairment, particularly in strain, was present in the cancer patients before anti-cancer therapy [4,5]. However, LA remodeling in these patients is still a matter of debate [2,6].…”

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

“…However, few studies regarding three‐layer RV‐GLS have been reported thus far. Guerra et al found that the impairment of three‐layer GLS in patients with systemic sclerosis was homogeneous in the RV and heterogeneous in the LV (GLS‐epi most impaired), while Tadic et al demonstrated that a significant deterioration of RV‐GLS occurred in the endocardium and mid‐myocardium in chemo‐ and radio‐therapy‐naive patients with solid cancer. A reasonable explanation of these conflicting data, on one hand, could be the differences in cardiovascular risk factors and demographics of the study patients.…”

Left ventricular dysfunction before chemotherapy: Did we miss something?

“…LV circumferential and radial strains were not assessed in this study. 4,5 The difference existed not only in the global values of LV and RV strains, but also in layer-specific strain, which further implies transmural myocardial and not endocardial impairment, as it was usually presumed. Mavinkurve-Groothuis et al reported a significant reduction in LV longitudinal, circumferential, and radial strains in the children with acute lymphoblastic leukemia after anthracycline therapy than before treatment.…”

“…3 Our research group recently published studies in which it was shown not only that LV multidirectional strain (longitudinal, circumferential, and radial) was significantly decreased in chemotherapy-and radiotherapy-naïve patients with solid cancer, but also that right ventricular (RV) longitudinal strain was significantly reduced in the cancer patients in comparison with controls. 4,5 The difference existed not only in the global values of LV and RV strains, but also in layer-specific strain, which further implies transmural myocardial and not endocardial impairment, as it was usually presumed.…”