Early Detection and Prediction of Anthracycline-Induced Right Ventricular Cardiotoxicity by 3-Dimensional Echocardiography

Rui Zhao, MBBS; Fang Shu, MD; Chujie Zhang, MBBS; Feiyan Song, MBBS; Yuchen Xu, MBBS; Ye Guo, MD; Kai Xue, MD; Jinyi Lin, MD; Xianhong Shu, MD, PhD; David H. Hsi, MD; Leilei Cheng, MD, PhD

JACC. CardioOncology (Mar 2020)

Early Detection and Prediction of Anthracycline-Induced Right Ventricular Cardiotoxicity by 3-Dimensional Echocardiography

Rui Zhao, MBBS,
Fang Shu, MD,
Chujie Zhang, MBBS,
Feiyan Song, MBBS,
Yuchen Xu, MBBS,
Ye Guo, MD,
Kai Xue, MD,
Jinyi Lin, MD,
Xianhong Shu, MD, PhD,
David H. Hsi, MD,
Leilei Cheng, MD, PhD

Affiliations

Rui Zhao, MBBS: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
Fang Shu, MD: Department of Ultrasound, Danyang Hospital of Traditional Chinese Medicine, Jiangsu, China
Chujie Zhang, MBBS: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
Feiyan Song, MBBS: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
Yuchen Xu, MBBS: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
Ye Guo, MD: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
Kai Xue, MD: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
Jinyi Lin, MD: Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
Xianhong Shu, MD, PhD: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
David H. Hsi, MD: Department of Cardiology, Stamford Hospital and Vagelos Columbia University College of Physicians and Surgeons, Stamford, Connecticut, USA; Dr. David H. Hsi, Department of Cardiology, Stamford Hospital, Vagelos Columbia University College of Physicians and Surgeons, One Hospital Plaza, Stamford, Connecticut 06904.
Leilei Cheng, MD, PhD: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China; Address for correspondence: Dr. Leilei Cheng, Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai 200032, China.

Journal volume & issue: Vol. 2, no. 1
pp. 13 – 22

Abstract

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Objectives: The purpose of this study was to assess the associations between 3-dimensional echocardiography (3DE)-derived changes in right ventricular (RV) volumes and strains with subsequent RV cardiotoxicity in patients treated with anthracyclines. Background: Although early detection and prediction of left ventricular (LV) dysfunction has been widely studied in patients receiving anthracyclines, little is known about the early changes in RV size and function in this population. Methods: A total of 74 patients with diffuse large B-cell lymphoma who received 6 cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline or before chemotherapy (pre-chemotherapy) (T0); after 2 cycles (T1); after 4 cycles (T2); and at the end of 6 cycles of chemotherapy (T3). Right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), ejection fraction (RVEF), longitudinal free wall strain (RVLFS), and longitudinal septal strain (RVLSS) were quantified by 3DE. RV cardiotoxicity was defined as a relative reduction of >10% in 3D RVEF or a relative reduction of >5% to a value of 12.4% (sensitivity, 78.6%; specificity, 82.6%; area under the curve (AUC), 0.80; p ＜ 0.001); and a relative increase in RVESV of >13.2% (sensitivity, 71.4%; specificity, 71.7%; AUC, 0.76; p ＜0.001) from baseline to T2 predicted subsequent RV cardiotoxicity at T3. IVCD and RAP did not change significantly over time. Conclusions: 3DE-derived measurements of RV strain and volume were associated with subsequent changes in RVEF. With further study, RVLFS and RVESV could potentially be used to predict subsequent declines in RVEF with anthracyclines.

Published in JACC. CardioOncology

ISSN: 2666-0873 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jacc-cardiooncology

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