The Early Predictive Value of Right Ventricular Strain in Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer

Overview

Journal Acta Cardiol Sin

Date 2016 Oct 8

PMID 27713603

Citations 23

Authors

Wei-Ting Chang

Jhih-Yuan Shih

Yin-Hsun Feng

Chun-Yen Chiang

Yu Hsuan Kuo

Wei-Yu Chen

Hong-Chang Wu

Juei-Tang Cheng

Jhi-Joung Wang

Zhih-Cherng Chen

Affiliations

Soon will be listed here.

Abstract

Background: As cancer therapies have improved, patient life spans have been extended but quality of life has been threatened by chemotherapy induced cardiotoxicity. Most cardiac complications remain unobserved until specific symptoms develop. Speckle-tracking echocardiography is a sensitive imaging modality in detecting early occult myocardial dysfunction.

Methods: A total number of 35 patients newly diagnosed with breast cancer and preparing for epirubicin therapy were prospectively recruited. Echocardiography, including speckle-tracking echocardiography, was performed sequentially at baseline (T1), after the first cycle (T2) and after the third cycle (T3) of epirubicin. At each visit, the severity of dyspnea was evaluated by the assessment scale.

Results: Compared with the baseline, right ventricular longitudinal strain (RVLS_FW) at T2 significantly declined (-22.49 ± 4.97 vs. -18.48 ± 4.46, p = 0.001), which was also positively associated with the development of dyspnea (R = 0.8, p = 0.01). At T3, both the left ventricular global longitudinal strain and RVLS_FW were significantly impaired (-21.4 ± 4.12 vs. -16.94 ± 6.81%; -22.49 ± 4.97 vs. -16.86 ± 7.27%, p = 0.01; 0.001, respectively). Also, the accumulating dose of epirubicin positively correlated with the development of dyspnea (R = 0.38, p = 0.04) and the decline of RVLS_FW (R = 0.53, p = 0.02). Notably, compared with the other echocardiographic parameters only RVLS_FW at the early stage (T2) significantly correlated with the development of dyspnea (odds ratio: 1.84, 95% confidence interval: 1.22-2.78, p = 0.04).

Conclusions: RVLS_FW sensitively predicts dyspnea development in breast cancer patients receiving epirubicin therapy. However, larger scale studies are required to validate its role in long-term patient survival.

Citing Articles

Anthracycline-Induced Subclinical Right Ventricular Dysfunction in Breast Cancer Patients: A Systematic Review and Meta-Analysis.

Faggiano A, Gherbesi E, Giordano C, Gamberini G, Vicenzi M, Cuspidi C Cancers (Basel). 2024; 16(22).

PMID: 39594841 PMC: 11592457. DOI: 10.3390/cancers16223883.

Effect of Radiotherapy on the Right Ventricular Function in Lung Cancer Patients.

Slawinski G, Hawryszko M, Lasocka-Koriat Z, Romanowska A, Myszczynski K, Wrona A Cancers (Basel). 2024; 16(11).

PMID: 38893098 PMC: 11171340. DOI: 10.3390/cancers16111979.

Chemotherapy induced right ventricular cardiomyopathy; a systematic review and meta-analysis.

Theetha Kariyanna P, Kumar A, Jayarangaiah A, Shetty M, Chowdhury Y, Das S Front Cardiovasc Med. 2023; 10:1103941.

PMID: 37600030 PMC: 10434797. DOI: 10.3389/fcvm.2023.1103941.

New Insights in the Era of Clinical Biomarkers as Potential Predictors of Systemic Therapy-Induced Cardiotoxicity in Women with Breast Cancer: A Systematic Review.

Alexandraki A, Papageorgiou E, Zacharia M, Keramida K, Papakonstantinou A, Cipolla C Cancers (Basel). 2023; 15(13).

PMID: 37444400 PMC: 10340234. DOI: 10.3390/cancers15133290.

Detection of right ventricular dysfunction by three - dimensional echocardiography and two - dimensional speckle tracking in breast cancer patients receiving anthracycline- based chemotherapy.

El-Sherbeny W, Sabry N, El-Saied S, Elnagar B Cardiooncology. 2023; 9(1):20.

PMID: 37024988 PMC: 10077607. DOI: 10.1186/s40959-023-00169-y.

References

Voigt J, Pedrizzetti G, Lysyansky P, Marwick T, Houle H, Baumann R . Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015; 28(2):183-93. DOI: 10.1016/j.echo.2014.11.003. View

Florescu M, Cinteza M, Vinereanu D . Chemotherapy-induced Cardiotoxicity. Maedica (Bucur). 2013; 8(1):59-67. PMC: 3749765. View

Vitarelli A, Cortes Morichetti M, Capotosto L, De Cicco V, Ricci S, Caranci F . Utility of strain echocardiography at rest and after stress testing in arrhythmogenic right ventricular dysplasia. Am J Cardiol. 2013; 111(9):1344-50. DOI: 10.1016/j.amjcard.2013.01.279. View

Mason J, Bristow M, Billingham M, Daniels J . Invasive and noninvasive methods of assessing adriamycin cardiotoxic effects in man: superiority of histopathologic assessment using endomyocardial biopsy. Cancer Treat Rep. 1978; 62(6):857-64. View

Jurcut R, Wildiers H, Ganame J, Dhooge J, De Backer J, Denys H . Strain rate imaging detects early cardiac effects of pegylated liposomal Doxorubicin as adjuvant therapy in elderly patients with breast cancer. J Am Soc Echocardiogr. 2008; 21(12):1283-9. DOI: 10.1016/j.echo.2008.10.005. View

Rudski L, Lai W, Afilalo J, Hua L, Handschumacher M, Chandrasekaran K . Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology,.... J Am Soc Echocardiogr. 2010; 23(7):685-713. DOI: 10.1016/j.echo.2010.05.010. View

Plana J, Galderisi M, Barac A, Ewer M, Ky B, Scherrer-Crosbie M . 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. PMC: 4402366. DOI: 10.1093/ehjci/jeu192. View

Khouri M, Douglas P, Mackey J, Martin M, Scott J, Scherrer-Crosbie M . Cancer therapy-induced cardiac toxicity in early breast cancer: addressing the unresolved issues. Circulation. 2012; 126(23):2749-63. PMC: 3667651. DOI: 10.1161/CIRCULATIONAHA.112.100560. View

Tanindi A, Demirci U, Tacoy G, Buyukberber S, Alsancak Y, Coskun U . Assessment of right ventricular functions during cancer chemotherapy. Eur J Echocardiogr. 2011; 12(11):834-40. DOI: 10.1093/ejechocard/jer142. View

10.

Miyoshi T, Tanaka H, Kaneko A, Tatsumi K, Matsumoto K, Minami H . Left ventricular endocardial dysfunction in patients with preserved ejection fraction after receiving anthracycline. Echocardiography. 2013; 31(7):848-57. DOI: 10.1111/echo.12473. View

11.

Ganame J, Claus P, Eyskens B, Uyttebroeck A, Renard M, Dhooge J . Acute cardiac functional and morphological changes after Anthracycline infusions in children. Am J Cardiol. 2007; 99(7):974-7. DOI: 10.1016/j.amjcard.2006.10.063. View

12.

Eyskens B, Ganame J, Claus P, Boshoff D, Gewillig M, Mertens L . Ultrasonic strain rate and strain imaging of the right ventricle in children before and after percutaneous closure of an atrial septal defect. J Am Soc Echocardiogr. 2006; 19(8):994-1000. DOI: 10.1016/j.echo.2006.02.001. View

13.

Shiino K, Sugimoto K, Yamada A, Takada K, Kawai H, Sugimoto K . Usefulness of right ventricular basal free wall strain by two-dimensional speckle tracking echocardiography in patients with chronic thromboembolic pulmonary hypertension. Int Heart J. 2015; 56(1):100-4. DOI: 10.1536/ihj.14-162. View

14.

Ky B, Putt M, Sawaya H, French B, Januzzi Jr J, Sebag I . Early increases in multiple biomarkers predict subsequent cardiotoxicity in patients with breast cancer treated with doxorubicin, taxanes, and trastuzumab. J Am Coll Cardiol. 2013; 63(8):809-16. PMC: 4286181. DOI: 10.1016/j.jacc.2013.10.061. View

15.

Kittiwarawut A, Vorasettakarnkij Y, Tanasanvimon S, Manasnayakorn S, Sriuranpong V . Serum NT-proBNP in the early detection of doxorubicin-induced cardiac dysfunction. Asia Pac J Clin Oncol. 2012; 9(2):155-61. DOI: 10.1111/j.1743-7563.2012.01588.x. View

16.

Haddad F, Doyle R, Murphy D, Hunt S . Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008; 117(13):1717-31. DOI: 10.1161/CIRCULATIONAHA.107.653584. View

17.

Liu K, Chen J, Chen S, Chu P . Cardiovascular Toxicity of Molecular Targeted Therapy in Cancer Patients: A Double-Edged Sword. Acta Cardiol Sin. 2016; 29(4):295-303. PMC: 4804894. View

18.

Wysong A, Couch M, Shadfar S, Li L, Li L, Rodriguez J . NF-κB inhibition protects against tumor-induced cardiac atrophy in vivo. Am J Pathol. 2011; 178(3):1059-68. PMC: 3070568. DOI: 10.1016/j.ajpath.2010.12.009. View

19.

Volkova M, Russell 3rd R . Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Curr Cardiol Rev. 2012; 7(4):214-20. PMC: 3322439. DOI: 10.2174/157340311799960645. View

20.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View