Abstract
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.
Highlights
Cardiotoxicity from anthracyclin chemotherapy is a leading cause of death in patients with cancer
On follow-up, on the 10th week, we found 7 patients had impaired right ventricular (RV) strain, so we divided the patients in group 1 into two subgroups 1A and 1B according to RV strain; group 1A included 93 patients with normal RVGLS and group 1B included 7 patients with decreased RVGLS
Ages of the patients and BSA were significantly higher in group 1B than group 1A; RV strain values were significantly decreased in group 1B than the other group
Summary
Cardiotoxicity from anthracyclin chemotherapy is a leading cause of death in patients with cancer. Left ventricular (LV) function is routinely assessed during protocol to detect cardiotoxicity; animal studies suggest that right ventricular (RV) function may be impaired. Osteosarcoma is considered the most common primary malignant bone tumor in childhood and adolescents. It occurs frequently in the long bones and rarely in jaw and fingers. It accounts for around 5% of all pediatric malignancies. The standard treatment protocol of chemotherapy is a combination of doxorubicin, cisplatin, and methotrexate which have cardiotoxic effect [1]. Prior research work has thoroughly focused on left ventricular (LV) dysfunction in patients receiving cardiotoxic chemotherapy. Diagnosis of RV dysfunction has been propelled to the forefront of research work as several studies substantiate the belief
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