Right ventricular strain as a predictor of trastuzumab-induced chemotherapy-related cardiac dysfunction: a meta-analysis

Trastuzumab (TZ) is an effective chemotherapeutic drug associated with left ventricular dysfunction, leading to cardiotoxicity. Two-dimensional speckle-tracking echocardiography has demonstrated efficacy in predicting TZ-induced cardiotoxicity; however, its role using right ventricular (RV) strain parameters remains unclear.

The current meta-analysis compared pre- and post-TZ RV strain parameters measured on two-dimensional speckle-tracking echocardiography.

A systematic search was conducted across PubMed/MEDLINE, Embase, and Cochrane Library from inception until June 2024. The outcomes of interest were the RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS). RevMan version 5.4 was used to pool standardized mean differences (SMD) with their corresponding 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at p<0.05.

Four studies involving 275 patients with cancer were included in this meta-analysis. The mean age of the patients was 53.35 ± 11.1 years. Pooled analysis demonstrated that TZ-based chemotherapy resulted in a statistically significant reduction in RV GLS [SMD: -0.58; 95% CI: -0.94, -0.22; p=0.001] and RV FWLS [SMD: -0.54; 95% CI: -0.99, -0.08; p=0.02].

Following TZ-based chemotherapy, RV subclinical damage ensues, leading to the deformation of RV mechanics. This meta-analysis demonstrated a reduction in RV GLS and RV FWLS following TZ-based chemotherapy, as detected by speckle-tracking echocardiography. Further multicenter randomized studies are required to validate the findings of the present meta-analysis.