DISCOVERIES (ISSN 2359-7232), 2019, April-June issue

CITATION: 

Submitted: June 5th, 2019; Revised: June 24th, 2019; Accepted: June 25th, 2019; Published: June 27th, 2019; 

 GO BACK to 2019, April-June issue

 GO BACK to DISCOVERIES

Longitudinal strain analysis allows the identification of subclinical deterioration of right ventricular function in patients with cancer therapy-related left ventricular dysfunction

Diana Alexandra Cherata (1), Ionuț Donoiu (2, *), Rodica Diaconu (2), Adina Glodeanu (1,3), Doina Cârstea (1,3), Constantin Militaru (2), Octavian Istrătoaie (2)

(1) Department of Cardiology, “Filantropia” Municipal Hospital, Craiova, Romania;
(2) Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania;
(3) Department of Medical semiology, University of Medicine and Pharmacy, Craiova, Romania;

*Corresponding author: Ionuț Donoiu, MD, PhD, University of Medicine and Pharmacy of Craiova, Department of Cardiology, Petru Rareș Street no. 2, Craiova, 200349, Romania; Phone: +40746126669; Fax: +40251426688; Email: ionut.donoiu@umfcv.ro

Abstract

Background: This study was designed to assess right ventricular systolic function in cancer patients.

Methods and Results: 68 consecutive patients receiving potentially cardiotoxic agents were followed for 6 months in a single-center, observational, cohort-study. Left ventricle and free-wall right ventricular longitudinal strain were analyzed prior and after 6 months of treatment, using a vendor-independent software, together with left ventricle ejection fraction, tricuspid annulus plane systolic excursion and right ventricular fractional area change. Cancer therapy-related cardiac dysfunction was defined as a left ventricle ejection fraction drop of >10% to <53%. Both left ventricle ejection fraction (59±7% vs. 55±8%, p<0.0001) and left ventricle longitudinal strain (−19.7±2.5% vs. −17.1±2.6%, p<0.0001) were reduced at follow up, along with free-wall right ventricular longitudinal strain (−24.9±4.5% vs. −21.6±4.9%, p<0.0001). Cancer therapy-related cardiac dysfunction was detected in 20 patients (29%). In 15 out of these 20 patients (75%), a concomitant relative reduction in free-wall right ventricular longitudinal strain magnitude by 17±7% was detected. Moreover, there was a significant correlation between left ventricle and free-wall right ventricular longitudinal strain at follow-up examinations (r=0.323, p<0.0001). A relative drop of right ventricular longitudinal strain >17% had a sensitivity of 55% and a specificity of 70% (AUC=0.75, 0.7-0.8, 95% CI) to identify patients with cancer treatment related cardiac dysfunction. Neither tricuspid annulus plane systolic excursion (24±5 vs. 23±4 mm, p=0.07), nor right ventricular fractional area change (45±8% vs. 44±7%, p=0.6) showed any significant change between examinations.

Conclusions: Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected.

Access full text of the manuscript here: Full text (pdf)

References

1. Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014; 15(10): 1063-93.
2. Eschenhagen T, Force T, Ewer MS, et al. Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2011; 13: 1-10.
3. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines:  The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(36): 2768-801.
4. Cardinale D, Colombo A, Lamantia G, et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol. 2010; 55(3): 213-20.
5. Thavendiranathan P, Poulin F, Lim KD, et al. Use of Myocardial Strain Imaging by Echocardiography for the Early Detection of Cardiotoxicity in Patients During and After Cancer Chemotherapy: A Systematic Review. J Am Coll Cardiol. 2014; 63: 2751-68.
6. Hardegree EL, Sachdev A, Villarraga HR, et al. Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol. 2013; 111: 143-8.
7. Hayek S, Sims DB, Markham DW, et al. Assessment of right ventricular function in left ventricular assist device candidates. Circ Cardiovasc Imaging. 2014; 7: 379-89.
8. Lisi M, Cameli M, Righini FM, et al. RV longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure. JACC Cardiovasc Imaging. 2015; 8: 514-22.
9. Haddad F, Doyle R, Murphy DJ, et al. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008; 117: 1717-31.
10. Murninkas D, Alba AC, Delgado D, et al. Right ventricular function and prognosis in stable heart failure patients. J Card Fail. 2014; 20: 343-9.
11. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28: 1-39. e14.
12. Barendswaard EC, Prpic H, van der Wall EE, et al. Right ventricle wall motion abnormalities in patients treated with chemotherapy. Clin Nucl Med. 1991; 16(7): 513-6.
13. Grover S, Leong DP, Chakrabarty A, et al. Left and right ventricular effects of anthracycline and trastuzumab chemotherapy: a prospective study using novel cardiac imaging and biochemical markers. Int J Cardiol. 2013; 168(6): 5465-7.
14. Tanindi A, Demirci U, Tacoy G, et al. Assessment of right ventricular functions during cancer chemotherapy. Eur J Echocardiogr. 2011; 12(11): 834-40.
15. Ganame J, Claus P, Uyttebroeck A, et al. Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients. J Am Soc Echocardiogr. 2007; 20(12): 1351-8.
16. Yağci-Küpeli B, Varan A, Yorgun H, et al. Tissue Doppler and myocardial deformation imaging to detect myocardial dysfunction in pediatric cancer patients treated with high doses of anthracyclines. Asia Pac J Clin Oncol. 2012; 8(4): 368-74.
17. Oliveira GH, Dupont M, Naftel D, et al. Increased need for right ventricular support in patients with chemotherapy-induced cardiomyopathy undergoing mechanical circulatory support: outcomes from the INTERMACS Registry (Interagency Registry for Mechanically Assisted Circulatory Support). J Am Coll Cardiol. 2014; 63(3): 240-8.
18. Calleja A, Poulin F, Khorolsky C, et al. Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy. J Oncol. 2015; 2015: 609194.
19. Boczar KE, Aseyev O, Sulpher J, et al. Right heart function deteriorates in breast cancer patients undergoing anthracycline-based chemotherapy. Echo Res Pract. 2016; 3(3): 79-84.
20. Abdar Esfahani M, Mokarian F, Karimipanah M. Alterations in the echocardiographic variables of the right ventricle in asymptomatic patients with breast cancer during anthracycline chemotherapy. Postgrad Med J. 2017; 93(1099): 271-4.
21. Chang WT, Shih JY, Feng YH, et al. The Early Predictive Value of Right Ventricular Strain in Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer. Acta Cardiol Sin. 2016; 32(5): 550-9.
22. Cardinale D, Colombo A, Bacchiani G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015; 131: 1981-8.
23. Muraru D, Onciul S, Peluso D, et al. Sex- and Method-Specific Reference Values for Right Ventricular Strain by 2-Dimensional Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging. 2016; 9(2): e003866.
24. Farsalinos KE, Daraban AM, Ünlü S, et al. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: The EACVI/ASE Inter-Vendor Comparison Study. J Am Soc Echocardiogr. 2015; 28(10): 1171-81, e2.