Key result
A relative drop in right ventricular longitudinal strain >17% identified cancer therapy-related cardiac dysfunction with a sensitivity of 55%, specificity of 70%, and an AUC of 0.75.
Why the study?
This study was designed to assess right ventricular systolic function in cancer patients receiving potentially cardiotoxic agents.
Does longitudinal strain analysis identify subclinical right ventricular dysfunction in cancer patients receiving cardiotoxic therapy?
Cohort (n=68)
No
Does longitudinal strain analysis identify subclinical right ventricular dysfunction in cancer patients receiving cardiotoxic therapy?
Effect estimate: AUC 0.75 (95% CI 0.7-0.8)
Longitudinal strain analysis can detect subclinical right ventricular dysfunction during cancer treatment before conventional indices like TAPSE or fractional area change are affected.
Modest diagnostic performance should not change cardio-oncology practice; leaves open prospective validation of right ventricular strain.
BACKGROUND: This study was designed to assess right ventricular systolic function in cancer patients. METHODS AND RESULTS: 68 consecutive patients receiving potentially cardiotoxic agents were followed for 6 months in a single-center, observational, cohort-study. Left ventricle and free-wall right ventricular longitudinal strain were analyzed prior and after 6 months of treatment, using a vendor-independent software, together with left ventricle ejection fraction, tricuspid annulus plane systolic excursion and right ventricular fractional area change. Cancer therapy-related cardiac dysfunction was defined as a left ventricle ejection fraction drop of >10% to <53%. Both left ventricle ejection fraction (59±7% vs. 55±8%, p<0.0001) and left ventricle longitudinal strain (-19.7±2.5% vs. -17.1±2.6%, p<0.0001) were reduced at follow up, along with free-wall right ventricular longitudinal strain (-24.9±4.5% vs. -21.6±4.9%, p<0.0001). Cancer therapy-related cardiac dysfunction was detected in 20 patients (29%). In 15 out of these 20 patients (75%), a concomitant relative reduction in free-wall right ventricular longitudinal strain magnitude by 17±7% was detected. Moreover, there was a significant correlation between left ventricle and free-wall right ventricular longitudinal strain at follow-up examinations (r=0.323, p<0.0001). A relative drop of right ventricular longitudinal strain >17% had a sensitivity of 55% and a specificity of 70% (AUC=0.75, 0.7-0.8, 95% CI) to identify patients with cancer treatment related cardiac dysfunction. Neither tricuspid annulus plane systolic excursion (24±5 vs. 23±4 mm, p=0.07), nor right ventricular fractional area change (45±8% vs. 44±7%, p=0.6) showed any significant change between examinations. CONCLUSIONS: Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected.
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Cherata et al. (2019) conducted a cohort in Cancer therapy-related cardiac dysfunction (n=68). Potentially cardiotoxic agents vs. Baseline (prior to treatment) was evaluated on Identification of cancer treatment-related cardiac dysfunction using a relative drop of right ventricular longitudinal strain >17% (AUC 0.75, 95% CI 0.7-0.8). A relative drop in right ventricular longitudinal strain >17% identified cancer therapy-related cardiac dysfunction with a sensitivity of 55%, specificity of 70%, and an AUC of 0.75.
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