Evaluation Of Right Ventricular Function In Patients With Breast Cancer After Chemotherapy By Two-Dimansional Speckle Tracking Imaging

ObjectiveAlthough left ventricular dysfunction after cancer chemotherapy in breast cancer cases has been fully investigated,there are a few investigations about the right ventricular functions.The purpose of this study was to evaluate the early changes of right ventricular function associated with anthracycline treatment for breast cancer by two-dimensional speckle tracking technology,which help clinical early detected subclinical impairment of myocardial function,and actively take preventive measures to reduce the risk of further myocardial damage.MethodsThirty hospital patients who were newly diagnosed of breast cancer survivors(mean age,44.83±7.92 years)between September 2016 and September 2017,scheduled to be treated with epirubicin-based chemotherapy,were prospectively enrolled.Conventional and 2D speckle-tracking echocardiography were performed sequentially at baseline,at the second cycle and the fourth cycle of epirubicin chemotherapy during 24 hours.Right ventricular wall thickness,right ventricle basal segment diameter,middle segment diameter,and right ventricular area change rate were calculated.Measurement of three apical annular systolic displacement by M echocardiography.Myocardial systolic and diastolic(early/late)velocities were measured in apical four-chamber view by sample volume at the junction of the tricuspid valve cusp and right ventricle free wall.Two-dimensional speckle tracking echocardiography was conducted to evaluate right ventricle global longitudinal peak systolic strain,global longitudinal peak systolic strain rate along with right ventricle longitudinal strain of the free wall.Comparing the measured data between groups,explore the correlation between the cumulative dose of epirubicin and global longitudinal strain and strain rate of right ventricle.Results1.There was no significant difference in the age,height,weight,and blood pressure of breast cancer patients before and after the chemotherapy(P>0.05).2.There was no statistical difference in RVD1,RVD2 and RVWT of breast cancer patients before and after the chemotherapy(P>0.05).3.Compared with baseline,right ventricular diastolic function parameters E′ decreased,E/E′ ratio increased,and right ventricular overall functional parameters Tei index increased after the four cycles of chemotherapy,the difference was statistically significant(P<0.05).4.Compared with the two cycles of chemotherapy and the baseline,The RVGLS decreased significantly after four chemotherapeutic cycles as well as RVFWS reduced remarkably at the same time(P<0.01).5.Compared with the baseline,RVGLSRs were reduced at the fourth cycle of chemotherapeutic while RVGLSRs showed no significant variation at the second cycle of chemotherapeutic.Epirubicin cumulative dose were negatively correlated with RVGL S,RVFWS,and RVGLSRs.Conclusion1.Right ventricular systolic and diastolic function were impaired in patients with breast cancer during early phases of the chemotherapy,and right systolic ventricular dysfunction may emerge earlier than the diastolic function.With cumulative dose of epirubicin increased,the right ventricular systolic and diastolic dysfunction become more obviously.2.Tissue Doppler and Tei index provided valuable information in demonstrating early right ventricular myocardial function changes after chemotherapy,due to less sensitivity it was not the best ultrasonic detection method.3.Two-dimensional speckle tracking technology can identify the impairment of right ventricular myocardial function in patients with breast cancer during early phases of the chemotherapy and are more sensitive in detecting the right ventricular subclinical cardiac toxicity compared with conventional ultrasound parameters.