Prevalence of Right Ventricle Strain Changes following Anthracycline Therapy

Michal Laufer-Perl, Moran Perelman-Gvili, Svetlana Sirota Dorfman, Guy Baruch, Ehud Rothschild, Gil Beer, Yaron Arbel, Joshua H Arnold, Zach Rozenbaum, Shmuel Banai, Yan Topilsky, Livia Kapusta, Michal Laufer-Perl, Moran Perelman-Gvili, Svetlana Sirota Dorfman, Guy Baruch, Ehud Rothschild, Gil Beer, Yaron Arbel, Joshua H Arnold, Zach Rozenbaum, Shmuel Banai, Yan Topilsky, Livia Kapusta

Abstract

Background: Anthracycline (ANT) is the most recognized therapy known to cause cardiotoxicity, mainly left ventricle (LV) dysfunction. Global Longitudinal Strain (GLS) is the optimal tool for assessment of subclinical LV dysfunction. Right ventricle (RV) function has been recognized as an independent factor for cardiac outcomes; however, data evaluating RV GLS is limited. We aimed to evaluate the change in RV GLS following ANT therapy.

Methods: The study cohort is part of the Israel Cardio-Oncology Registry (ICOR). All patients performed echocardiography before (T1) and at the end (T3) of ANT therapy. A significant reduction was defined as a relative reduction of ≥10% in RV GLS values.

Results: The study included 40 female patients with breast cancer treated with ANT. During follow-up, both RV GLS and free wall longitudinal strain systolic peak (RV FWLS PK) decreased significantly (p < 0.001 and p = 0.002). Altogether, 30 (75%) and 23 (58%) patients showed RV GLS and RV FWLS PK ≥ 10% relative reduction. At T3, LV ejection fraction and LV GLS were within normal range.

Conclusions: RV GLS and RV FWLS PK reduction following ANT exposure is extremely frequent, comparing to LV GLS reduction.

Keywords: anthracycline; cardio-oncology; cardiotoxicity; right ventricle; strain.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The assessment of right ventricle Global Longitudinal Strain. (A) Determining of the region of interest; (B) evaluating the Global Longitudinal Strain of the right ventricle; (C) evaluating the free wall by excluding the septal wall and including the RV free wall (basal, mid, and apical) segments solely.
Figure 1
Figure 1
The assessment of right ventricle Global Longitudinal Strain. (A) Determining of the region of interest; (B) evaluating the Global Longitudinal Strain of the right ventricle; (C) evaluating the free wall by excluding the septal wall and including the RV free wall (basal, mid, and apical) segments solely.
Figure 2
Figure 2
Right ventricle strain reduction during ANT therapy. (A) Reduction in RV GLS values from T1 to T3; (B) reduction in RV FWLS PK values from T1 to T3; (C) reduction in RV GLS septum PK values form T1 to T3. ANT = Anthracycline, RV = Right Ventricle, GLS = Global Longitudinal Strain, FWLS PK = Free Wall Peak Systolic, PK = Peak Systolic, T1 = baseline before ANT therapy, T2 = during ANT therapy, T3 = end of ANT therapy.
Figure 2
Figure 2
Right ventricle strain reduction during ANT therapy. (A) Reduction in RV GLS values from T1 to T3; (B) reduction in RV FWLS PK values from T1 to T3; (C) reduction in RV GLS septum PK values form T1 to T3. ANT = Anthracycline, RV = Right Ventricle, GLS = Global Longitudinal Strain, FWLS PK = Free Wall Peak Systolic, PK = Peak Systolic, T1 = baseline before ANT therapy, T2 = during ANT therapy, T3 = end of ANT therapy.

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