Right ventricular free wall strain for detection of anthracycline induced cardiac toxicity

Anthracycline agents are routinely used for treatment of many types of malignancy, while imposing the risk for cardiotoxicity (AT-CMP). Although the right ventricle (RV) is more susceptible to cardiotoxicity, most of the studies have focused on left ventricle (LV) function for monitoring AT-CMP. In this study, we have focused on RV function before and after chemotherapy using two-dimensional speckle tracking Echocardiography. In this prospective study, newly diagnosed and untreated cancerous patients without previous cardiovascular diseases were enrolled. For all patients, baseline echocardiography was performed before the initiation of the anthracycline regimen and after 6 months of follow up when the chemotherapy was stopped. Several parameters of LV and RV function were measured using 3D echocardiography and STE techniques. 60 patients were enrolled in the study. There was a significant decrease (P = 0.001) in RV fractional area change (53.57% ± 4.36 vs. 45.66% ± 6.19), RV Global longitudinal strain (GLS) (- 22.93% ± 1.95 vs. - 18.53 ± 2.75), and RV free wall strain (FWLS) (- 25.75% ± 3.01 VS. - 20.30 ± 3.78). There was a significant decline in LVEF (59.42 ± 6.36% vs. 51.1 ± 6.31%) and LV-GLS (- 21.1 ± 1.8% vs - 18.6 ± 2.6%) (both P = 0.001) as well. Among the parameters changed following chemotherapy, RV-FWLS was dropped to a pathological level in 25% of patients showing the highest potential for detection of anthracyclines effect on the myocardium. Anthracycline therapy can induce subclinical RV dysfunction. In this clinical setting, RV free wall strain shows a great ability to exhibit deleterious effects of anthracyclines on the myocardium. This finding needs to be confirmed in future and larger studies.