Cardiotoxicity has become a significant adverse effect of cancer therapy, with Anthracyclines (ANT) in particular. There is a crucial need for the early subclinical detection of cardiotoxic effect. We aimed to evaluate Right ventricle (RV) two-dimensional speckle tracking echocardiography (2D-STE) changes during ANT therapy and to assess the correlation between RV 2D-STE and the routine echocardiographic RV parameters.

Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). All female patients with breast cancer, planned for ANT therapy were included. All patients underwent serial echocardiography exams including baseline RV 2D-STE (before chemotherapy, T1) and shortly after the completion of ANT therapy (T3). RV 2D-STE was evaluated using the apical 4 chamber (4C) RV-focused view, assessing both the combined RV free wall and inter-ventricular septum (RV GLS) and solely the RV free wall strain (RV FWLS). Significant reduction in both RV GLS and RV FWLS was determined by either a relative reduction of >10% or an absolute value of >−25% for RV GLS and >−29% for RV FWLS.

From September 2016 to June 2019, 40 patients were evaluated with a mean Doxorubicin (type of ANT) dose of 238.5±9.4 mg/m². RV FWLS showed significant correlation to Tricuspid annular plane systolic excursion. At T3, significant reduction in both RV GLS and RV FWLS was observed among 77% and 62% of the patients with a mean RV GLS and RV FWLS reduction from −26.8 (±4.7) % to −21.5 (±4.4) % and −28.9 (±5.1) % to −25.6 (±5.9) % (p<0.001, p=0.002), respectively. Left ventricle (LV) ejection fraction and LV GLS were within the normal range.

RV GLS and RV FWLS reduction are frequent and occur early in the course of ANT therapy, preceding LV dysfunction, which may imply for the role of RV 2D-STE in the detection of early cardiotoxicity.

Type of funding sources: None.