Mechanical property evaluation of the right ventricular myocardium in cancer patients with chemotherapy by echocardiography: a systematic review and meta-analysis

Background: Cancer therapy-related cardiotoxicity has recently become an area of intense research. As the prognostic role of the right ventricle (RV) in a variety of cardiovascular diseases has been confirmed, and several studies have paid increased attention to RV function in cancer patients who have underwent chemotherapy, we provide a meta-analysis to objectively evaluate the mechanical properties of the right ventricular myocardium by echocardiography in this population. Methods: We systematically searched Embase, PubMed, and Cochrane databases were applied to search for studies (published before August 11, 2021) comparing RV contraction measured by echocardiography at baseline to follow-up in cancer patients who underwent chemotherapy or radiotherapy. The mechanical properties of the right ventricular myocardium were pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), systolic velocity of tricuspid annulus (S'), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), and right ventricular fractional area change (RVFAC). We analyzed pooled data using a random-effects model and assessed risk of bias in the included studies using the Newcastle-Ottawa Scale. Results: Twenty-one trials were enrolled (N=1,355 participants). Cancer patients who underwent chemotherapy but not radiotherapy showed an increase in PASP [standardized mean difference (SMD) =0.161, 95% CI: 0.007 to 0.316) compared with the condition at baseline, as well as reductions in TAPSE (SMD =-0.543, 95% CI: -0.698 to -0.389), S' (SMD =-0.507, 95% CI: -0.748 to -0.266), RVFWLS (SMD =0.833, 95% CI: 0.549 to 1.118) and RVGLS (SMD =1.017, 95% CI: 0.751 to 1.283). There was no significant difference in RVFAC (SMD =-0.097, 95% CI: -0.213 to 0.018). Furthermore, these indicators pointed to a deterioration of right ventricular contraction function in cancer patients who underwent chemotherapy and radiotherapy. The risk of bias of the included studies evaluated by the Newcastle-Ottawa Scale was medium to high. Discussion: Right ventricular contraction function would deteriorate in cancer patients who underwent chemotherapy and radiotherapy, especially with the prolongation of chemotherapy duration and accumulation of chemotherapeutic drugs. Further studies are needed to establish the definition of right ventricular systolic dysfunction in clinical practice.