Abstract
Background: This study was designed to assess right ventricular systolic function in cancer patients. Methods and Results: 68 consecutive patients receiving potentially cardiotoxic agents were followed for 6 months in a single-center, observational, cohort-study. Left ventricle and free-wall right ventricular longitudinal strain were analyzed prior and after 6 months of treatment, using a vendor-independent software, together with left ventricle ejection fraction, tricuspid annulus plane systolic excursion and right ventricular fractional area change. Cancer therapy-related cardiac dysfunction was defined as a left ventricle ejection fraction drop of >10% to <53%. Both left ventricle ejection fraction (59±7% vs. 55±8%, p<0.0001) and left ventricle longitudinal strain (−19.7±2.5% vs. −17.1±2.6%, p<0.0001) were reduced at follow up, along with free-wall right ventricular longitudinal strain (−24.9±4.5% vs. −21.6±4.9%, p<0.0001). Cancer therapy-related cardiac dysfunction was detected in 20 patients (29%). In 15 out of these 20 patients (75%), a concomitant relative reduction in free-wall right ventricular longitudinal strain magnitude by 17±7% was detected. Moreover, there was a significant correlation between left ventricle and free-wall right ventricular longitudinal strain at follow-up examinations (r=0.323, p<0.0001). A relative drop of right ventricular longitudinal strain >17% had a sensitivity of 55% and a specificity of 70% (AUC=0.75, 0.7-0.8, 95% CI) to identify patients with cancer treatment related cardiac dysfunction. Neither tricuspid annulus plane systolic excursion (24±5 vs. 23±4 mm, p=0.07), nor right ventricular fractional area change (45±8% vs. 44±7%, p=0.6) showed any significant change between examinations.Conclusions: Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected.
Highlights
This study was designed to assess right ventricular systolic function in cancer patients
Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected
Cancer therapy-related cardiac dysfunction (CTRCD) diagnosis is conventionally based on the measurement of left ventricular ejection fraction (LVEF), using various cardiac imaging modalities
Summary
Study population Consecutive patients receiving potentially cardiotoxic agents and undergoing clinically indicated echocardiography studies for CTRCD monitoring, before and after 6 months of treatment, as main indication, were enrolled in a single-center, observational cohort-study. Patients were selected for acceptable image quality, excluding patients with two or more segments not visualized by conventional 2DE. For each patient the following data were obtained: patient demographics, cardiac risk factors and previous cardiac and malignancy history. All patients gave their informed consent in agreement with the local Ethics Committee. Image acquisition Complete 2DE studies were performed prior and 6 months after receiving potential cardiotoxic treatment by experienced sonographers using commercially available ultrasound machines: Vivid
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