Right Ventricular Functional Changes During Predominantly Anthracycline-Containing Cancer Therapy: An Umbrella Review of Echocardiographic Evidence

Background: Cardiac surveillance during cancer therapy has traditionally focused on the left ventricle, although the right ventricle (RV) may also be affected. Objective: To appraise and synthesize systematic reviews of echocardiographic RV changes during predominantly anthracycline-containing cancer therapy. Methods: This registered umbrella review (PROSPERO CRD420261461273) followed PRIOR and the relevant principles of PRISMA 2020. Five databases were searched, supplemented by backward and forward citation searching. Methodological quality, review-level risk of bias, certainty of evidence, and primary-study overlap were assessed using AMSTAR 2, ROBIS, an adapted GRADE framework, and the Corrected Covered Area (CCA), respectively. Results: Four systematic reviews with meta-analyses (2022–2025) were included, comprising 76 primary-study occurrences representing 40 unique studies. AMSTAR 2 confidence was critically low and ROBIS overall risk of bias was unclear for all four reviews. Primary-study overlap was very high (CCA = 30.0%). RV global longitudinal strain (RVGLS) and free-wall longitudinal strain (RVFWLS) showed the most consistent group-level changes; where mean differences were reported, pooled declines were approximately 1.0–3.2 percentage points. Conventional, hemodynamic and volumetric measures changed less consistently or were sparsely reported. Certainty of evidence was very low for all evaluated outcomes. Conclusions: RV strain remains a candidate marker of treatment-associated RV changes. However, concordance across overlapping reviews does not represent independent replication, the changes cannot be attributed specifically to anthracyclines, and whether they exceed measurement variability is unknown. Prospective studies with appropriate comparators, standardized serial RV imaging and patient-important outcomes are needed.