Anthracycline chemotherapy is a common component of many cancer treatment regimens. These chemotherapies are highly effective, but are sometimes associated with increased rates of cardiac toxicity. During chemotherapy treatment, cardiotoxicity is monitored by measuring changes in the left ventricle ejection fraction (LVEF). However, according to a recent study, the right ventricle (RV) may be more heavily impacted by chemotherapy, and RVEF monitoring during chemotherapy allows for earlier detection of chemotherapy-induced cardiotoxicity. The study used 3-D transthoracic echocardiography (TTE) with strain imaging to evaluate cardiac function in 74 patients with diffuse large B cell lymphoma (DLBCL) treated with 6 cycles of R-CHOP chemotherapy. Cardiotoxicity was defined as a > 10% relative reduction in RVEF or a relative reduction of > 5% to an absolute value of < 45%.
A total of 36% of patients developed cardiac toxicity after 6 cycles of chemotherapy, with RVEF decreasing from 54.8% to 48.3% and falling below 45% in 4 patients. Both RV end-systolic and end-diastolic volume had increased significantly after 4 cycles of chemotherapy, and RV longitudinal free-wall strain had worsened. Changes in RV end-systolic volume (P = .002) and RV longitudinal free-wall strain (P = .001) were both found to be significantly associated with subsequent RV cardiotoxicity. A relative decrease of more than 13.2% in RV end-systolic volume was found to identify patients with RV cardiotoxicity, as was a change of more than 12.4% in RV longitudinal free-wall strain.
The investigators concluded that monitoring certain RV parameters, including end-systolic volume and longitudinal free-wall strain, during anthracycline chemotherapy may allow for earlier identification of patients experiencing chemotherapy-induced cardiotoxicity. However, longer follow-up and a larger cohort size will be needed before these monitoring techniques can be used in clinical practice.
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