Key result
In breast cancer patients receiving anthracyclines and/or anti-HER2 therapy, TAPSE decreased from 21.7 to 20.8 mm and RV-FWS worsened from -31.0% to -29.2% over 12 months.
Why the study?
Cardiotoxic therapies in breast cancer have traditionally focused on left ventricular impairment, but right ventricular function may also be compromised.
Does treatment with anthracyclines and/or trastuzumab reduce right ventricular function in women with newly diagnosed breast cancer?
Does treatment with anthracyclines and/or trastuzumab reduce right ventricular function in women with newly diagnosed breast cancer?
Breast cancer patients receiving anthracyclines or trastuzumab experience a progressive, subclinical decline in right ventricular function over the first year of treatment, highlighting the need for biventricular surveillance.
Background Cardiotoxic therapies in breast cancer have traditionally focused on left ventricular impairment, yet right ventricular (RV) function may also be compromised. Emerging data suggest that subclinical RV dysfunction can appear early in the treatment course, underscoring the need for comprehensive biventricular assessment. Purpose To describe the evolution of RV function parameters over 12 months in a prospective cohort of breast cancer patients receiving anthracyclines and/or anti-HER2 therapies. Methods We enrolled 185 women with newly diagnosed breast cancer, scheduled for treatment with anthracyclines and/or trastuzumab. Echocardiographic assessments were conducted at baseline (n=185) and approximately 3 months (n=177), 6 months (n=165), and 12 months (n=143) post-baseline to evaluate right ventricular (RV) function. The parameters analyzed included tricuspid annular plane systolic excursion (TAPSE), S wave velocity (S′), fractional area change (FAC), and RV free wall strain (RV-FWS), with values summarized as means and standard deviations at each time point. To model longitudinal changes while accounting for variations in follow-up duration and attrition, we applied mixed linear effects models. Time was included as a fixed effect, while subject ID was treated as a random effect to account for intra-individual variability across repeated measures. Results From baseline to 12 months, TAPSE decreased from 21.7±2.3 to 20.8±2.3 mm and S′ from 12.2±1.9 to 11.5±1.9 cm/s (both p<0.05). FAC changed only modestly (49±7% to 48±6%), while RV-FWS became less negative (−31.0±5.4% to −29.2±4.5%, p<0.05), consistent with impaired contractility. The mixed models confirmed that TAPSE and S′ declined significantly at each follow-up, whereas RV-FWS deteriorated most notably at 12 months. These findings indicate a progressive subclinical decrease in RV function in this cohort. Conclusion In breast cancer patients undergoing anthracycline- and/or anti-HER2–based therapy, RV functional indices show a measurable decline within the first year. Early recognition of RV involvement highlights the importance of comprehensive biventricular echocardiographic surveillance in this population.
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Guerra et al. (2025) studied this question. In breast cancer patients receiving anthracyclines and/or anti-HER2 therapy, TAPSE decreased from 21.7 to 20.8 mm and RV-FWS worsened from -31.0% to -29.2% over 12 months.
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