3D echocardiography may predict right ventricular EF changes after cancer treatment
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Measurements of right ventricular volume and strain from 3D echocardiography were linked to later changes in right ventricular ejection fraction, according to a study published in JACC: CardioOncology.
“Right ventricular end-systolic volume, ejection fraction, longitudinal free wall strain may serve as important makers for RV toxicity,” David H. Hsi, MD, FACC, FASE, chief of cardiology and co-director of the Heart and Vascular Institute at Stamford Hospital and professor of clinical medicine at Columbia University College of Physicians and Surgeons, told Healio.
Patients with lymphoma
Rui Zhao, MBBS, of the department of echocardiography at Zhongshan Hospital at Fudan University in Shanghai; Leilei Cheng, MD, PhD, principal investigator and director of cardio-oncology at Zhongshan Hospital at Fudan University and colleagues analyzed data from 74 patients (mean age, 49 years; 33 women) with diffuse large B-cell lymphoma who received six cycles of anthracycline-based treatment. Echocardiography was performed before initiation of chemotherapy and after every two cycles thereafter for the duration of treatment. Researchers used 3D echocardiography to measure end-systolic volume, right ventricular end-diastolic volume, right ventricular EF, longitudinal septal strain and longitudinal free-wall strain.
“For traditional monitoring for patients undergoing anthracycline-based chemotherapy, cardiologists and oncologists focused on the left ventricle for ejection fraction changes and more recently 2D strain imaging for early signs of impairment,” Hsi said in an interview. “There has been paucity of data about the potentially deleterious impact on the right ventricle.”
For this study, right ventricular cardiotoxicity was defined as a relative reduction in 3D right ventricular EF of 10% or greater or a relative reduction of at least 5% and no more than 45%. Volume status was assessed through estimated right atrial pressure and inferior vena cava diameter.
From baseline to the end of the fourth cycle of chemotherapy, there were increases in right ventricular end-systolic volume (27.8 mL to 31.3 mL; P < .001) and right ventricular end-diastolic volume (58.5 mL to 64.2 mL; P < .001). Changes were also observed in right ventricular longitudinal free-wall strain during this time (27.3% to 24.2; P < .001).
Researchers observed declines in right ventricular EF (54% to 49.8%; P < .001) and right ventricular longitudinal septal strain (26.1% to 22.9%; P < .001) at the end of the six cycles of chemotherapy.
A relative increase in right ventricular end-systolic volume of greater than 13.2% (sensitivity, 71.4%; specificity, 71.7%; area under the curve, 0.76; P < .001) and a relative decrease in right ventricular longitudinal free-wall strain of greater than 12.4% (sensitivity, 78.6%; specificity, 82.6%; AUC, 0.8; P < .001) predicted future right ventricular cardiotoxicity after six cycles of chemotherapy were completed.
No significant changes in right atrial pressure and inferior vena cava diameter were observed over time.
‘Strong clinical interest’
“If confirmed by other investigators, we can potentially monitor the early toxicity of the left and right ventricle and provide meaningful guidance for clinicians for potential therapeutic adjustment,” Hsi told Healio. “Chemotherapy-induced right ventricular toxicity is a relatively new concept. There will be strong clinical interest for further research in this regard.” – by Darlene Dobkowski
For more information:
David H. Hsi, MD, FACC, FASE, can be reached at dhsi@stamhealth.org.
Disclosures: The authors report no relevant financial disclosures.
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