174 EVALUATION OF SUBCLINICAL RIGHT VENTRICULAR CARDIOTOXICITY BY ADVANCED ECHOCARDIOGRAPHY IN PATIENTS WITH BREAST CANCER TREATED WITH ANTHRACYCLINES
Authors: Gambino Grazia , Lisi Daniela Di , Palermo Antonio Di , Triolo Oreste Fabio , Rossetto Ludovico , Myriam Intravaia Rita Cristina , Buccheri Giancarlo , Passavanti Giulia , Galassi Alfredo Ruggero , Novo Giuseppina 
Published: December 2022

Abstract

Background
Chemotherapeutic drugs may cause many complications affecting the cardiovascular system. There is a strong evidence suggesting the impact of this drugs on the left ventricle (LV), whereas less data regarding cardiotoxicity on the right ventricle (RV) exist.

Purpose
The aim of this study was to intercept early subclinical RV changes in patients treated with anthracyclines, using advanced echocardiography, with the hope that these could potentially be used to predict ventricular dysfunction.

Methods
In our single-center study, 20 female patients with breast cancer treated with anthracyclines were enrolled from 2019 to 2021. Cardiological evaluation and echocardiogram were performed at baseline (T0), 3 months (T1) and 6 months (T2) after initiation of chemotherapy. RV systolic function was calculated by estimation of conventional 2D echocardiographic and Doppler parameters (TAPSE, S’RV, FAC). Advanced echocardiography evaluation of right ventricular function was performed to quantify the following parameters: 3D right ventricular end-diastolic volume (RVEDV), 3D end-systolic volume (RVESV), 3D stroke volume (RVSV), 3D ejection fraction (RVEF), global longitudinal strain of the RV (RVGLS) and longitudinal free wall strain of the RV (RVLFS).

Results
Only 2 patients developed cardiotoxicity according to the criteria of the 2022 ESC Guidelines. Regarding the impact of chemotherapy on RV function, no statistically significant changes were found in conventional echocardiographic parameters (TAPSE, S’RV, FAC). In contrast, speckle tracking analysis of the RV showed a statistically significant reduction in both global strain [global RVGLS -23.3 ± 2.2% at T0 vs -19.5 ± 10.9% at T1 (p&lt;0.0001); global RVGLS -23.3 ± 2.2% at T0 vs -19.8 ± 3.2% at T2 (p&lt;0.0001)] and free wall strain [RVLFS -30.02 ± 3.3% at T0 vs -18.2 ± 21.2% at T1 (p=0.0001); RVLFS -30.02 ± 3.3% at T0 vs -23.7 ± 4.6% at T2 (p=0.0006)]. We observed a statistically significant increase in RVEDV at T1 compared to baseline [3D RVEDV 81.3 ± 16,9 ml al T0 vs 82.6 ± 19.2 ml at T1 (p=0,04)], whereas there were no significant changes at T2. Estimation of RVESV revealed the same trend, with a statistically significant increase in this parameter at T1 compared to baseline [3D RVESV 34.4 ± 10.4 ml at T0 vs 37.8 ± 10.8 ml at T1 (p=0.01)]. In relation to the RVEF, a minimal statistically significant reduction was observed at both T1 and T2 compared to T0 [3D RVEF 63.7 ± 4.3% at T0 vs 62.7 ± 4% at T1 (p= 0.01); 3D RVEF 63.7 ± 4.3% at T0 vs 58.7 ± 6% at T2 (p= 0.02)].

Conclusions
RV speckle tracking and 3D echocardiography seemed to intercept subclinical damage due to anthracyclines earlier than conventional parameters. Further studies are needed to confirm our results and to evaluate their prognostic impact.