Abstract 18966: Right Ventricular Dysfunction is Common in Patients With Breast Cancer Experiencing Cardiotoxicity During Adjuvant Trastuzumab Therapy
Background: Cardiotoxicity (CTOX) during cancer chemotherapy is commonly identified using a threshold reduction in left ventricular ejection fraction (LVEF) from pre-therapy values. Right ventricular (RV) dysfunction is not considered in the definition of CTOX. We examined the hypothesis that RV dysfunction will be present in a subset of patients experiencing CTOX.
Methods: We retrospectively analyzed echocardiograms (echo) performed in consecutive breast cancer patients referred to a heart function clinic for management of CTOX during adjuvant trastuzumab therapy. All patients had an echo performed during the first clinical visit and were not on cardio-protective therapy. RV function was assessed using fractional area change (FAC) and global longitudinal peak systolic strain (VVI software, Siemens, Figure) using a 4 chamber view. Ten healthy volunteers were used as controls for RV strain measurements.
Results: A total of 27 female pts (age 53 ± 12yrs) were included. Mean 2D biplane LVEF was 53.5 ± 9.3% with 13/27 having an LVEF <55%. The mean RV FAC for all patients was 39.6 ± 9.0%, with 7/27 (26%) having an abnormal FAC (<35%). LVEF was normal in 4 of these 7 patients. Including all 6 RV segments mean RV global longitudinal strain was -17.1 ± 7.4% versus -25.4 ± 2.2% in controls (p=0.001). Limiting the analysis to the 3 RV lateral wall segments, the mean longitudinal strain in patients was -22.9 ± 3.6% versus -30.0 ± 3.3% in controls (p=0.007). Using a strain cut off value of -23.5% for the lateral wall (2SD below mean for normal), 9/20 (45%) with normal FAC had had abnormal RV peak systolic longitudinal strain.
Conclusion: Amongst patients referred for management of CTOX, 26% had significant RV systolic dysfunction. However, and additional 45% of the patients had subclinical RV dysfunction based on a reduced RV longitudinal strain. RV dysfunction should be considered as an important parameter in the assessment of patients referred for the assessment of cardiotoxicity.
- © 2013 by American Heart Association, Inc.