Echocardiographic changes in the right ventricle during chemotherapy - a systematic review and meta-analysis

Cancer therapy-induced cardiotoxicity (CTRCD) is a significant adverse effect of oncologic treatment, associated with considerable morbidity and mortality. Among CTRCD, heart failure stands out in prevalence and severity, with left ventricular dysfunction being the focus of most studies. Right ventricle (RV) may also be damaged by CTRCD, however the effects of CTRCD on RV function (RVF) have not been elucidated.

We aimed to conduct a systematic review and meta-analysis evaluating RV echocardiographic parameters in patients undergoing chemotherapy.

PubMed, Embase and Cochrane were searched for studies that evaluated RV parameters during cancer therapy. Statistical analysis was performed using the R statistical software. We computed pooled mean differences (MD), adopting a random-effects model, with a significance level of 0.05. A conservative correlation coefficient of 0.5 was assumed for paired measurement, when necessary. Heterogeneity was assessed using the I² statistic.

We included 1520 patients from 25 studies, 73% of whom were women and with a mean age of 51.1±16.5 years. RVF was significantly lower after CTRCD, with reduction in fractional area change (MD=-2.29% [95% CI: -3.63,-0.95]) - Figure 1A, RV global longitudinal strain (MD=2.49% [95% CI: 1.73, 3.25]) - Figure 1B, and RV free wall strain (MD=3.21% [95% CI: 2.32, 4.11]) - Figure 1C. Additionally, tricuspid annular plane systolic excursion was significantly reduced (MD=-1.44mm [95% CI: -1.94, -0.95]) - Figure 2A, and pulmonary artery systolic pressure was significantly higher (MD=1.60mmHg [95% CI: 0.64, 2.56]) - Figure 2B, after chemotherapy.

The assessment of RVF is important in CTRCD, and its quantification should be included in clinical follow-up during cancer treatment. Further research is needed to elucidate the underlying factors contributing to RV dysfunction and to develop methods for its early detection.