Right ventricular strain dynamics during anthracycline therapy in breast cancer patients stratified by cardiotoxicity risk: preliminary results

Abstract

Cancer-therapy-related cardiac dysfunction (CTRCD) is traditionally assessed using left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LV GLS). However, despite the recognized prognostic role of right ventricular (RV) function in other cardiovascular setting, RV deformation parameters are not included in current CTRCD definitions, are not routinely assessed in cardio-oncology, and remain incompletely characterized. To evaluate changes in RV strain parameters during anthracycline-based chemotherapy in breast cancer (BC) patients stratified by baseline cardiotoxicity risk, and to explore whether RV strain changes occur independently of conventional LV cardiotoxicity criteria. This prospective, single-center observational study included 71 consecutive women with BC (mean age 55.4 ± 11.2 years). Baseline cardiovascular risk was stratified using the HFA-ICOS score. All patients underwent cardiovascular monitoring and preventive management in accordance with the 2022 ESC Cardio-Oncology Guidelines. Comprehensive transthoracic echocardiography was performed at baseline (T0), during treatment (T1), and after completion of chemotherapy (T2). In addition to LVEF and LV GLS, right ventricular global longitudinal strain (RV GLS) and right ventricular free wall longitudinal strain (RV FWLS) were assessed. Subclinical RV dysfunction was operationally defined as a relative reduction of ≥15% in RV GLS from baseline. Patients were categorized into a low-risk group (group 1) and a combined moderate/high/very high-risk group (group 2). All patients received anthracycline-containing chemotherapy regimens with a mean cumulative anthracycline dose of 236.4 mg/m². Longitudinal changes across the three time points were analyzed using repeated-measures analysis with pairwise comparisons. Across the entire cohort, a significant overall time effect was observed for LV GLS, RV GLS and RV FWLS across T0, T1 and T2 (Table 1). Subclinical CTRCD defined by a relative reduction in LV GLS, was identified in 19 (26.7%) patients, while subclinical RV cardiotoxicity occurred in 16 (22.5%) patients. Notably, subclinical RV dysfunction was not accompanied by parallel changes in LVEF or LV GLS at the same time points. Anthracycline therapy is associated with progressive impairment of RV deformation parameters, which may occur in the absence of concurrent changes in conventional LV cardiotoxicity parameters as currently defined. These findings suggest that RV strain assessment provides information complementary to conventional LV–based cardiotoxicity criteria.Table 1