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Prevalence of RV dysfunction in patients under cardiotoxic chemoterapy: a preliminary analysis
Session:
Comunicações Orais (Sessão 16) - Doença CV em Populações Especiais
Speaker:
Sérgio Maltês
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; Bruno ml Rocha; Gonçalo jl Cunha; Mariana Paiva; Ana Carolina Vasques; Pedro Freitas; Sara Guerreiro; Liliana Marta; João Abecasis; Regina Ribeiras; Maria João Andrade; Carlos Aguiar; Ana Martins; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Chemotherapy-induced cardiotoxicity is a serious complication often leading to symptomatic heart failure. While the left ventricle (LV) has been thoroughly implicated in this process, data is scarce on right ventricular (RV) function following cardiotoxic chemotherapies. Our goal was to determine the prevalence and clinical significance of RV dysfunction in a cohort of patients who had received these drugs.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methodology</u><span style="color:#222222">: Single-center retrospective study of cancer patients performing 2D transthoracic echocardiogram between January 2020 and December 2021. Those previously exposed to anthracyclines and/or anti-HER2 agents (≥6 months prior to echocardiogram) were included. Patients with known coronary artery disease or cardiomyopathy were excluded, as were those with prior pulmonary embolism. LV function was assessed through LV ejection fraction (LVEF) and global longitudinal strain (GLS). LV cardiotoxicity was defined as per 2020 ESMO guidelines. </span>RV function was considered abnormal if any of the following criteria were met: tricuspid annular systolic plane excursion (<span style="color:#222222">TAPSE) <17mm, </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">lateral tricuspid annulus systolic velocity by pulsed wave Doppler tissue imaging </span></span>(<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">S’VD) <12cm/s, fraction area change (FAC) <35% and mean free wall longitudinal strain (FWLS) >-20%. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: Forty patients were included (mean age 58 ± 13 years; 95% female; 93% with breast cancer; 30%, 20% and 50% previously treated with anthracyclines, anti-HER2 or both, respectively). Mean LVEF and GLS were 56 ± 7% and -17 ± 3%, respectively. Overall, 13 patients had current LV </span>cardiotoxicity<span style="color:#222222">. </span>RV dysfunction was documented in 15 (38%) patients,<span style="color:#222222"> most often through FWLS – see figure 1. Seven patients (18%) and one patient (3%) had ≥2 and ≥3 abnormal RV parameters, respectively. Those with RV dysfunction were more often symptomatic (NYHA class ≥2: 53% vs. 16%; p=0.013), had higher NT-proBNP levels (</span>516 [204-2400] vs. 66 [46-191] pg/mL; p=0.003<span style="color:#222222">) and most often had LV cardiotoxicity (62% vs. 26%, p=0.029). Isolated RV dysfunction was observed in </span>7 (<span style="color:#222222">18%) patients. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Conclusion</span></u><span style="color:#222222">: In our cohort of patients treated with cardiotoxic anti-neoplastic drugs, RV dysfunction was frequent (approximately one in every five patients with isolated RV dysfunction), most often detected by RV 2D strain and associated with worse symptoms and higher NT-proBNP levels.</span></span></span></span></p>
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