Comprehensive Cardiac Monitoring in Female Breast Cancer Patients Undergoing Chemotherapy: Importance of Right Ventricular Global Longitudinal Strain Assessment

Abstract

Background: Breast cancer is the most frequently diagnosed malignancy globally, characterized by high survival rates but emerging concerns regarding non-cancer-related mortality. A notable issue in this population is cancer therapy-related cardiovascular toxicity (CTR-CVT). This study aimed to evaluate CTR-CVT in breast cancer patients with low cardiovascular risk undergoing chemotherapy, utilizing standard 2D echocardiography, speckle tracking echocardiography (STE), and NT-proBNP measurements. Methods: Forty-four female breast cancer patients with no prior cardiovascular disease or chemotherapy history scheduled to commence chemotherapy were recruited. Standard 2D echocardiography and STE were employed to assess both ventricles' global longitudinal strain (GLS). Results: Although conventional echocardiographic parameters such as left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) remained stable, a significant reduction in both left and right ventricular global longitudinal strain (GLS) was observed. Specifically, left ventricular GLS (LV-GLS) decreased from -20.2 ± 4.2 to -17.9 ± 5.2 (t-test = -3.35, df = 32, p = 0.002), while right ventricular free wall longitudinal strain (RV-FWLS) decreased from -23.2 ± 4.1 to -20.1 ± 4.2 (t-test = -2.98, df = 32, p = 0.001). Both RV-FWLS and LV-GLS decreased concurrently in 60% of patients. Isolated reductions in RV-FWLS were seen in 18% of patients, and isolated LV-GLS reductions were noted in 12%. NT-proBNP levels increased from 125.9 ± 124.4 pg/mL to 176.4 ± 166.8 pg/mL (t-test = -2.35, df = 32, p = 0.025; delta NT-proBNP = 50.5). Even in cases where NT-proBNP levels were stable, RV-FWLS exhibited a significant decline of over 15%. Conclusions: The results highlight the significance of assessing RV-FWLS, which demonstrated a notable decline alongside LV-GLS. This underscores the necessity for a comprehensive approach to cardiac function evaluation during chemotherapy.