Beyond the left ventricle: right ventricular function as an early marker of cancer therapy related cardiac dysfunction

Abstract

Cancer therapy–related cardiac dysfunction (CTRCD) remains a major limitation of anthracycline and anti-HER2 therapy, and most monitoring focuses on left ventricular (LV) function. Data on the role of right ventricular (RV) function as an early marker of CTRCD are limited. To evaluate the association between echocardiographic RV parameters - TAPSE, tricuspid S’ velocity and RV free-wall longitudinal strain (RV-FWLS) - and the development of CTRCD in patients treated with anthracyclines and/or anti-HER2 therapy. Retrospective, single-center observational study including patients treated with anthracyclines and/or anti-HER2 agents and followed in Cardio-oncology consultation in a district hospital. CTRCD was defined according to contemporary cardio-oncology criteria based on LV ejection fraction and global longitudinal strain. RV function was evaluated by TAPSE, tricuspid S’ and RV-FWLS. We included 65 women, mean age 60±10 years. Chemotherapy regimens comprised anthracyclines only in 45%, anti-HER2 therapy only in 10% and combined anthracyclines plus anti-HER2 in 45%. According to the HFA-ICOS tool, 34% were at low, 37% at moderate, 17% at high and 12% at very high cardiovascular risk at baseline. Over a median follow-up of 36 months (IQR 23–70), CTRCD occurred in 15 patients (23%). 9 patients (14%) died, including 2 cardiovascular deaths. At baseline, TAPSE and tricuspid S’ were similar in patients with and without CTRCD (TAPSE 22±2.7 vs 23±2.1mm, p=0.19; S’ 12.5±1.9 vs 12±1.8cm/s, p=0.30), whereas RV-FWLS was significantly less negative in those who subsequently developed CTRCD (−23.6±3.1% vs −26.1±2.8%, p=0.02). During follow-up, patients with CTRCD showed a greater decline in RV function, with larger reductions in TAPSE (−2±1.9 vs −0.5±1.5mm, p=0.01) and RV-FWLS (+4.8±3.7 vs +2.9±3%, p=0.04). A relative reduction in RV-FWLS ≥15% occurred in 60% of patients with CTRCD versus 20% of those without (p=0.01). In univariable logistic regression, baseline RV-FWLS was associated with higher odds of CTRCD (OR per 1% less negative strain 1.17, 95% CI [1.03–1.28], p=0.01). In this cohort of women treated with anthracyclines and anti-HER2 therapy, RV-FWLS identified patients who developed CTRCD, supporting RV strain as a useful tool for early risk stratification and refinement of cardio-oncology surveillance strategies.