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Abstract：
BACKGROUND: Anthracyclines can cause left ventricular (LV) dysfunction. There is little data about right ventricular (RV) damage during chemotherapy.
OBJECTIVE: This study aimed to investigate the toxic effects of chemotherapy, analyzing its impact on right ventricular function.
METHODS: A prospective study was conducted, enrolling 83 female patients (55 ± 11 years old) affected by breast cancer treated with anthracyclines. Cardiological evaluation, HFA risk score assessment and comprehensive echocardiogram, including speckle tracking analysis and 3D analysis, were performed before starting chemotherapy (T0) and at 3 (T1), 6 (T2) and 12 months (T3) after beginning treatment. RV function was assessed with tricuspid annular plane excursion (TAPSE), S\' wave of the tricuspid annulus, fractional area change (FAC), RV global longitudinal strain (RV-GLS), free wall strain (RV-FWLS) and RV 3D ejection fraction (RV-3DEF). Subclinical LV CTRCD was defined as a reduction of GLS > 15% compared to baseline. Subclinical RV cardiotoxicity was defined as the co-presence of a relative decrease of 10% from baseline in RV-3DEF and a relative reduction of 15% from baseline RV-FWLS.
RESULTS: After chemotherapy, we found a significant reduction in 2D-LVEF (p = < 0.001) and 3D-LVEF (p = < 0.001), in LV-GLS and RVLS (p = < 0.001), in FAC and TAPSE, also RV-3DEF reduced significantly (p = 0.002). 39% of patients developed LV subclinical CTRCD; 28% of patients developed RV subclinical cardiotoxicity. LV and RV changes occurred concomitantly, and no RV echocardiographic parameters were found to predict the development of LV CTRCD and vice-versa.
CONCLUSIONS: After anthracyclines-based chemotherapy, LV and RV subclinical damage occurs, and it can be detected early by speckle-tracking and 3D echocardiography.
OBJECTIVE: This study aimed to investigate the toxic effects of chemotherapy, analyzing its impact on right ventricular function.
METHODS: A prospective study was conducted, enrolling 83 female patients (55 ± 11 years old) affected by breast cancer treated with anthracyclines. Cardiological evaluation, HFA risk score assessment and comprehensive echocardiogram, including speckle tracking analysis and 3D analysis, were performed before starting chemotherapy (T0) and at 3 (T1), 6 (T2) and 12 months (T3) after beginning treatment. RV function was assessed with tricuspid annular plane excursion (TAPSE), S\' wave of the tricuspid annulus, fractional area change (FAC), RV global longitudinal strain (RV-GLS), free wall strain (RV-FWLS) and RV 3D ejection fraction (RV-3DEF). Subclinical LV CTRCD was defined as a reduction of GLS > 15% compared to baseline. Subclinical RV cardiotoxicity was defined as the co-presence of a relative decrease of 10% from baseline in RV-3DEF and a relative reduction of 15% from baseline RV-FWLS.
RESULTS: After chemotherapy, we found a significant reduction in 2D-LVEF (p = < 0.001) and 3D-LVEF (p = < 0.001), in LV-GLS and RVLS (p = < 0.001), in FAC and TAPSE, also RV-3DEF reduced significantly (p = 0.002). 39% of patients developed LV subclinical CTRCD; 28% of patients developed RV subclinical cardiotoxicity. LV and RV changes occurred concomitantly, and no RV echocardiographic parameters were found to predict the development of LV CTRCD and vice-versa.
CONCLUSIONS: After anthracyclines-based chemotherapy, LV and RV subclinical damage occurs, and it can be detected early by speckle-tracking and 3D echocardiography.
摘要：
背景：蒽环类药物可引起左心室（LV）功能障碍。关于化疗期间右心室（RV）损伤的数据很少。
目的：本研究旨在探讨化疗的毒性作用，分析其对右心室功能的影响。
方法：进行了一项前瞻性研究，招募83名女性患者（55±11岁）患有蒽环类药物治疗的乳腺癌。心脏病学评估,HFA风险评分评估和综合超声心动图，包括斑点跟踪分析和3D分析，在开始化疗之前（T0）和3（T1）进行，6（T2）和12个月（T3）后开端医治。用三尖瓣环平面偏移(TAPSE)评估右心室功能,三尖瓣环的S波，分数面积变化（FAC），RV全球纵向应变（RV-GLS），自由壁应变(RV-FWLS)和RV3D射血分数(RV-3DEF)。亚临床LVCTRCD定义为与基线相比GLS降低>15%。亚临床RV心脏毒性定义为RV-3DEF从基线相对降低10%和从基线RV-FWLS相对降低15%的共存。
结果：化疗后，我们发现2D-LVEF（p=<0.001）和3D-LVEF（p=<0.001）显着降低，在LV-GLS和RVLS中（p=<0.001），在FAC和TAPSE中，RV-3DEF也显著降低(p=0.002)。39%的患者发展为LV亚临床CTRCD;28%的患者发展为RV亚临床心脏毒性。LV和RV变化同时发生，并且没有发现RV超声心动图参数可以预测LVCTRCD的发展，反之亦然。
结论：蒽环类药物化疗后，发生LV和RV亚临床损伤，并且可以通过斑点追踪和3D超声心动图早期检测到。
目的：本研究旨在探讨化疗的毒性作用，分析其对右心室功能的影响。
方法：进行了一项前瞻性研究，招募83名女性患者（55±11岁）患有蒽环类药物治疗的乳腺癌。心脏病学评估,HFA风险评分评估和综合超声心动图，包括斑点跟踪分析和3D分析，在开始化疗之前（T0）和3（T1）进行，6（T2）和12个月（T3）后开端医治。用三尖瓣环平面偏移(TAPSE)评估右心室功能,三尖瓣环的S波，分数面积变化（FAC），RV全球纵向应变（RV-GLS），自由壁应变(RV-FWLS)和RV3D射血分数(RV-3DEF)。亚临床LVCTRCD定义为与基线相比GLS降低>15%。亚临床RV心脏毒性定义为RV-3DEF从基线相对降低10%和从基线RV-FWLS相对降低15%的共存。
结果：化疗后，我们发现2D-LVEF（p=<0.001）和3D-LVEF（p=<0.001）显着降低，在LV-GLS和RVLS中（p=<0.001），在FAC和TAPSE中，RV-3DEF也显著降低(p=0.002)。39%的患者发展为LV亚临床CTRCD;28%的患者发展为RV亚临床心脏毒性。LV和RV变化同时发生，并且没有发现RV超声心动图参数可以预测LVCTRCD的发展，反之亦然。
结论：蒽环类药物化疗后，发生LV和RV亚临床损伤，并且可以通过斑点追踪和3D超声心动图早期检测到。
