Limits...
Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy.

Calleja A, Poulin F, Khorolsky C, Shariat M, Bedard PL, Amir E, Rakowski H, McDonald M, Delgado D, Thavendiranathan P - J Oncol (2015)

Bottom Line: Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant.Conclusion.Despite appropriate management, LV dysfunction persisted in the majority at follow-up.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.

ABSTRACT
Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity. Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls. Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%, P = 0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < -20.3%) was seen in 40% (n = 12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n = 11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant. Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

No MeSH data available.


Related in: MedlinePlus

Right ventricular systolic longitudinal strain. Right ventricular peak endocardial strain curves. Left panel shows B-mode images of the RV in 4-chamber view with endocardial tracing and to its right is the corresponding strain curve in (a) control and (b) during cardiotoxicity. Right ventricular free wall longitudinal strain (RVFWLS) is composed of 3 segments while right ventricular peak systolic global longitudinal strain (RVGLS) includes all 6 segments (RV free wall and septum).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4539180&req=5

fig2: Right ventricular systolic longitudinal strain. Right ventricular peak endocardial strain curves. Left panel shows B-mode images of the RV in 4-chamber view with endocardial tracing and to its right is the corresponding strain curve in (a) control and (b) during cardiotoxicity. Right ventricular free wall longitudinal strain (RVFWLS) is composed of 3 segments while right ventricular peak systolic global longitudinal strain (RVGLS) includes all 6 segments (RV free wall and septum).

Mentions: Myocardial peak systolic longitudinal strain was measured offline for both the LV and RV based on the ASE recommendations [21] using commercially available software (Vector Velocity Imaging (VVI) 3.0, Siemens Medical Solutions, Mountain View, CA) using the speckle tracking technique. Briefly, apical 4-, 3-, and 2-chamber images of the LV and an apical 4-chamber view of the RV in DICOM format were obtained for each patient and loaded into the VVI software. Endocardial contours were drawn along the LV and RV border separately for measurement of respective longitudinal strain values (Figures 1 and 2). The contours were adjusted as needed to ensure adequate visual tracking of the endocardium. Any segments that were not tracked adequately after 5 attempts at adjustment were excluded from the analysis. LV peak systolic global longitudinal endocardial strain (GLS) was measured by taking the average of the peak endocardial strain curves in the apical 4-, 3-, and 2-chamber views (16-segment model) (Figure 1). As conventionally done, RV peak systolic global longitudinal endocardial strain (RVGLS) was measured from all 6 RV myocardial segments from an apical 4-chamber view (3 segments of the free wall and 3 segments of the interventricular septum) while the RV free wall peak systolic longitudinal strain (RVFWLS) was obtained from the 3 RV free wall segments only (Figure 2). This distinction is made since measurement of RVGLS based on the inclusion of the interventricular septum may partially reflect changes in the left ventricle as the septum is shared by both ventricles. RVFWLS focuses only on the RV free wall and does not include contribution of the septum; however, it does not account for potential changes that may occur in the RV septum.


Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy.

Calleja A, Poulin F, Khorolsky C, Shariat M, Bedard PL, Amir E, Rakowski H, McDonald M, Delgado D, Thavendiranathan P - J Oncol (2015)

Right ventricular systolic longitudinal strain. Right ventricular peak endocardial strain curves. Left panel shows B-mode images of the RV in 4-chamber view with endocardial tracing and to its right is the corresponding strain curve in (a) control and (b) during cardiotoxicity. Right ventricular free wall longitudinal strain (RVFWLS) is composed of 3 segments while right ventricular peak systolic global longitudinal strain (RVGLS) includes all 6 segments (RV free wall and septum).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4539180&req=5

fig2: Right ventricular systolic longitudinal strain. Right ventricular peak endocardial strain curves. Left panel shows B-mode images of the RV in 4-chamber view with endocardial tracing and to its right is the corresponding strain curve in (a) control and (b) during cardiotoxicity. Right ventricular free wall longitudinal strain (RVFWLS) is composed of 3 segments while right ventricular peak systolic global longitudinal strain (RVGLS) includes all 6 segments (RV free wall and septum).
Mentions: Myocardial peak systolic longitudinal strain was measured offline for both the LV and RV based on the ASE recommendations [21] using commercially available software (Vector Velocity Imaging (VVI) 3.0, Siemens Medical Solutions, Mountain View, CA) using the speckle tracking technique. Briefly, apical 4-, 3-, and 2-chamber images of the LV and an apical 4-chamber view of the RV in DICOM format were obtained for each patient and loaded into the VVI software. Endocardial contours were drawn along the LV and RV border separately for measurement of respective longitudinal strain values (Figures 1 and 2). The contours were adjusted as needed to ensure adequate visual tracking of the endocardium. Any segments that were not tracked adequately after 5 attempts at adjustment were excluded from the analysis. LV peak systolic global longitudinal endocardial strain (GLS) was measured by taking the average of the peak endocardial strain curves in the apical 4-, 3-, and 2-chamber views (16-segment model) (Figure 1). As conventionally done, RV peak systolic global longitudinal endocardial strain (RVGLS) was measured from all 6 RV myocardial segments from an apical 4-chamber view (3 segments of the free wall and 3 segments of the interventricular septum) while the RV free wall peak systolic longitudinal strain (RVFWLS) was obtained from the 3 RV free wall segments only (Figure 2). This distinction is made since measurement of RVGLS based on the inclusion of the interventricular septum may partially reflect changes in the left ventricle as the septum is shared by both ventricles. RVFWLS focuses only on the RV free wall and does not include contribution of the septum; however, it does not account for potential changes that may occur in the RV septum.

Bottom Line: Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant.Conclusion.Despite appropriate management, LV dysfunction persisted in the majority at follow-up.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.

ABSTRACT
Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity. Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls. Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%, P = 0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < -20.3%) was seen in 40% (n = 12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n = 11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant. Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

No MeSH data available.


Related in: MedlinePlus