Right ventricle involvement in patients with breast cancer treated with chemotherapy

Ludovico Rossetto; Daniela Di Lisi; Cristina Madaudo; Francesco Paolo Sinagra; Antonio Di Palermo; Oreste Fabio Triolo; Grazia Gambino; Antonella Ortello; Alfredo Ruggero Galassi; Giuseppina Novo

doi:10.1186/s40959-024-00224-2

Right ventricle involvement in patients with breast cancer treated with chemotherapy

Cardiooncology. 2024 Apr 15;10(1):24. doi: 10.1186/s40959-024-00224-2.

Authors

Ludovico Rossetto^#^{1

2}, Daniela Di Lisi^{3

4}, Cristina Madaudo^#^{1

2}, Francesco Paolo Sinagra^{1

2}, Antonio Di Palermo^{1

2}, Oreste Fabio Triolo^{1

2}, Grazia Gambino^{1

2}, Antonella Ortello^{1

2}, Alfredo Ruggero Galassi^{1

2}, Giuseppina Novo^{1

2}

Affiliations

¹ Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
² Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 129, Palermo, Italy.
³ Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy. danydilis@hotmail.it.
⁴ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 129, Palermo, Italy. danydilis@hotmail.it.

^# Contributed equally.

Abstract

Background: Anthracyclines can cause left ventricular (LV) dysfunction. There is little data about right ventricular (RV) damage during chemotherapy.

Aim: This study aimed to investigate the toxic effects of chemotherapy, analyzing its impact on right ventricular function.

Material and methods: A prospective study was conducted, enrolling 83 female patients (55 ± 11 years old) affected by breast cancer treated with anthracyclines. Cardiological evaluation, HFA risk score assessment and comprehensive echocardiogram, including speckle tracking analysis and 3D analysis, were performed before starting chemotherapy (T0) and at 3 (T1), 6 (T2) and 12 months (T3) after beginning treatment. RV function was assessed with tricuspid annular plane excursion (TAPSE), S' wave of the tricuspid annulus, fractional area change (FAC), RV global longitudinal strain (RV-GLS), free wall strain (RV-FWLS) and RV 3D ejection fraction (RV-3DEF). Subclinical LV CTRCD was defined as a reduction of GLS > 15% compared to baseline. Subclinical RV cardiotoxicity was defined as the co-presence of a relative decrease of 10% from baseline in RV-3DEF and a relative reduction of 15% from baseline RV-FWLS.

Results: After chemotherapy, we found a significant reduction in 2D-LVEF (p = < 0.001) and 3D-LVEF (p = < 0.001), in LV-GLS and RVLS (p = < 0.001), in FAC and TAPSE, also RV-3DEF reduced significantly (p = 0.002). 39% of patients developed LV subclinical CTRCD; 28% of patients developed RV subclinical cardiotoxicity. LV and RV changes occurred concomitantly, and no RV echocardiographic parameters were found to predict the development of LV CTRCD and vice-versa.

Conclusion: After anthracyclines-based chemotherapy, LV and RV subclinical damage occurs, and it can be detected early by speckle-tracking and 3D echocardiography.

Keywords: CTRCD; Cardio-oncology; Cardiotoxicity; Longitudinal strain; Right ventricle; Three-dimensional echocardiography.