Three dimensional speckle tracking echocardiography in breast cancer patients receiving chemotherapy: incidence and clinical outcomes of subclinical right ventricular systolic dysfunction

Abstract

Abstract Background The data about the influence of chemotherapy on right ventricular (RV) function and mechanics are scarce and conflicting. Due to the special geometric structure and unique wall motion of the RV, routine techniques for echocardiographic assessment of the RV has challenges. However, 3-dimensional echocardiography (3DE) tracks changes in RV volumes in real time, including the inflow and outflow tracts and the apex throughout the cardiac cycle. 3DE evaluation of RV function and morphology has been compared to cardiac magnetic resonance and is accurate, feasible, and reproducible Methods This study conducted was a retrospective cohort study which included 75 breast cancer patients who underwent chemotherapy at a tertiary hospital from January 2019 to May 2021 to determine clinical outcomes of patients among those who developed an abnormal right ventricular longitudinal free wall strain and global longitudinal strain in terms of all-cause mortality, development of overt right ventricular systolic dysfunction, and adverse cardiovascular events. Results There was a striking statistically significant difference in terms of right ventricular ejection fraction among those who developed an abnormal right ventricular global longitudinal strain at 6 and 12 months post-chemotherapy with a p-value of 0.001 and 0.000 respectively. The difference between the 2 groups of patients in terms of right ventricular global longitudinal strain 6 and 12 months after chemotherapy was also statistically significant (p=0.000). As for the left ventricle, the LV ejection fraction and global longitudinal strain were also statistically significantly different at 12 months post-chemotherapy. Among those who developed an abnormal RV global longitudinal strain, the LV global longitudinal strain was also subsequently lower compared to the normal subgroup at 12 months post-treatment. Conclusion Although the sample size was small, the development of abnormal RV GLS post-chemotherapy was generally associated with subsequent development of overt heart failure, increased all-cause mortality, and CV death. The use of echocardiographic RV GLS surveillance to guide chemotherapy is crucial to enhance clinical outcomes and survival. Funding Acknowledgement Type of funding sources: None.