ASSOCIATION BETWEEN RIGHT VENTRICLE FUNCTION WITH LEFT VENTRICLE CARDIOTOXICITY IN BREAST CANCER PATIENTS UNDERWENT ANTHRACYCLINE CHEMOTHERAPY AT DR SARDJITO HOSPITAL

Abstract

Background: In Indonesia, breast cancer remains the leading cause of newly diagnosed cancers. Anthracyclines are the first-line treatment for solid tumors, but the presence of cardiotoxic side effects has diminished the efficacy of anticancer therapy. Left ventricular systolic dysfunction and right ventricle dysfunction can both be caused by anthracyclines because these drugs can damage and kill the heart muscle cells. Currently, the assessment of anthracycline-induced cardiotoxicity has only focused on the left ventricle, despite the fact that right ventricular structures are also susceptible to anthracycline-induced damage. Global longitudinal strain is a novel echocardiographic parameter that can detect early alterations in contractility function.

Aim: To determine the association between right ventricular function and left ventricular cardiotoxicity in breast cancer patients undergoing anthracycline chemotherapy.

Research Methods: This research is an observational cross-sectional study with retrospective data collection. Includes data from 36 over 18-year-old patients with breast cancer who received anthracycline chemotherapy for the first time as a basic regimen at RSUP Dr. Sardjito between July 2018 and November 2021 and underwent a baseline echocardiography exam and an evaluation echocardiography after administration of anthracycline chemotherapy. Right ventricular function was measured using RV-GLS parameters, and left ventricular cardiotoxicity was assessed as a 15% or greater decrease in LV-GLS from baseline.

Results: This study included 36 female breast cancer patients with a mean age of 53,19 ± 8,50 years. Nine patients were diagnosed with left ventricular cardiotoxicity. Patients with right ventricular systolic dysfunction (RV-GLS -20%) comprised 7 (78%) of those who developed left ventricular cardiotoxicity, while patients with normal right ventricular function (RV-GLS -20%) comprised only 2 (22%). Patients with left ventricular cardiotoxicity had a prevalence of right ventricular systolic dysfunction (RV-GLS -20%) of 78%, while patients without left ventricular cardiotoxicity had a prevalence of right ventricular systolic dysfunction (RV-GLS -20%) of 44%, resulting in a prevalence ratio (PR) of 1.78, but this difference was not statistically significant (PR 1,78 p = 0.128, 95% CI 0.75-13.07).

Conclusion: Patients with left ventricular cardiotoxicity had a higher incidence of right ventricular systolic dysfunction than patients without left ventricular cardiotoxicity, although the association was not statistically significant.

Keywords: Global longitudinal strain, echocardiography, cardiotoxicity, anthracyclines, breast cancer