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

Area of Science:

• Cardiology
• Oncology
• Cardio-oncology

Background:

• Anthracycline chemotherapy is a cornerstone treatment for breast cancer.
• Cardiotoxicity, particularly right ventricular (RV) dysfunction, is a known side effect.
• Early detection of subclinical RV dysfunction is essential for patient management.

Purpose of the Study:

• To evaluate the impact of anthracycline chemotherapy on subclinical RV dysfunction in breast cancer patients.
• To compare the sensitivity of traditional echocardiographic parameters versus strain-based measures (RV global longitudinal strain [RV GLS] and RV free-wall longitudinal strain [RV FWLS]) in detecting early RV dysfunction.

Main Methods:

• A systematic literature search was conducted following PRISMA guidelines.
• Included 15 studies with 1148 breast cancer patients undergoing anthracycline chemotherapy.
• Meta-analysis of changes in RV GLS, RV FWLS, TAPSE, FAC, and TDI S' pre- and post-chemotherapy.

Main Results:

• Significant declines in RV function were observed post-chemotherapy across all assessed parameters.
• RV GLS decreased from 23.99% to 20.35% (SMD: -0.259, p < 0.0001).
• RV FWLS decreased from 24.92% to 21.56% (SMD: -0.269, p < 0.0001).
• Reductions in traditional parameters were less consistent.
• Meta-regression indicated RV dysfunction may not solely result from left ventricular impairment.

Conclusions:

• Anthracycline chemotherapy induces subclinical RV dysfunction in breast cancer patients.
• RV strain analysis, particularly 3D strain, demonstrates higher sensitivity for early dysfunction detection.
• Further research is needed to establish the clinical significance and prognostic value of these findings and the role of RV strain analysis in guiding interventions.