Analysis of right ventricular function to detect early cardiac dysfunction in breast cancer patients during initial cycles of anthracycline-based chemotherapy

Advances in chemotherapy have not only increased the survival rate of breast cancer patients, but also heightened the awareness of cancer-therapy related cardiovascular disease (CTRCD). Speckle tracking echocardiography (STE) with its rapidly advancing technology, is the preferred method for accurately defining early cardiac dysfunction in breast cancer patients underwent chemotherapy.

This study evaluates the efficacy of right ventricular (RV) analysis via STE in detecting early cardiac dysfunction in breast cancer patients receiving anthracycline-based chemotherapy.

Breast cancer patients were assessed with STE before and after the third cycle of chemotherapy. Assessments included measurements of left ventricle ejection fraction (LVEF), global longitudinal strain (GLS), left atrium (LA) and right ventricle (RV) strain, tricuspid annular plane systolic excursion (TAPSE) and left atrial volume index (LAVI). Data was analyzed with SPSS program. Cardiotoxicity stratification was calculated according to the International Cardio-Oncology Society (IC-OS) criteria.

Between January and March 2024, 24 breast cancer patients at a single tertiary medical center underwent two serial STE before and after their third cycle of chemotherapy. Of these, 21 patients (87.5%) were classified as low risk and 3 patients (12.5%) as moderate risk for CTRCD. Baseline STE parameters showed mean LVEF of 61.83+6.04%; GLS of -16.37+3.17%; TAPSE of 21.79+4.18 mm; RV strain of 19.42+4.74%; and LAVI of 29.96+9.20 ml/m². Strong positive correlation were observed between baseline and serial STE for GLS (r=0.656; p<0.001) and LAVI (r=0.729; p<0.001). No significant changes in any STE parameters from baseline to serial assessments (P>0.05). Additionally, a strong negative correlation was found between baseline GLS and RV strain (r=-0.650; p=0.001) and between baseline RV strain and serial GLS (r=-0.440; p=0.032). A strong positive correlation was observed between baseline RV strain and LA strain (SCD, r=0.448; p=0.02) and between baseline LVEF and serial RV strain (r=0.411; p=0.046).

Despite low CTRCD incidence, the strong correlations between right and left ventricular parameters suggest that detailed right heart analysis is crucial for detecting early cardiac dysfunction in chemotherapy patients. Further research with a larger cohort is recommended to validate these findings and refine monitoring protocols.

Graphs of correlation