Objectives To investigate breast cancer therapy-related myocardial cardiotoxicity by analyzing right ventricular (RV), left atrial (LA), and right atrial (RA) function using cardiovascular magnetic resonance feature tracking (CMR-FT). Materials and methods This prospective single-center study involved 38 female breast cancer patients with a mean age of 50 ± 11 years, who received systemic anthracycline chemotherapy. CMR was performed in all patients before initiating therapy (at baseline (BL)) and after a 12-month follow-up (FU). FT was utilized to evaluate the RV global longitudinal (GLS), radial (GRS), and circumferential strain (GCS), as well as the biatrial reservoir, booster, and conduit strain. Paired t-tests were used to assess the differences in strain values from BL to FU. Results The mean RV GLS of all patients was significantly attenuated at FU compared to BL (−25.2 ± 3.9% at BL vs −20.6 ± 4.4% at FU, p < 0.001), whereas RV GRS and GCS showed no significant change. LA reservoir strain was significantly reduced at FU (24.1 ± 3.2 at BL vs 22.7 ± 3.3% at FU, p = 0.005), while LA booster and conduit strain showed non-significant change. Similarly, RA reservoir strain decreased significantly from BL to FU (24.9 ± 3.3% at BL vs 23.2 ± 2.9% at FU, p = 0.019), whereas RA booster and conduit strain did not significantly change from BL to FU. Conclusions Cancer therapy-related cardiac dysfunction (CTRCD) is not confined to the LV but affects the RV and the atria as well. Changes in RV GLS and LA/RA reservoir strain could serve as additional markers of subclinical cardiotoxicity in breast cancer patients. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> The role of RV and biatrial strain in detecting CTRCD is unclear. <Emphasis Type="BoldItalic">Findings</Emphasis> Biatrial reservoir strain and RV GLS were significantly attenuated after breast cancer therapy. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> RV GLS and biatrial reservoir strain might serve as early markers of subclinical cardiotoxicity after breast cancer therapy and should thus be routinely determined in patients with suspected CTRCD. Graphical Abstract

Right ventricular and biatrial CMR strain analysis detects myocardial functional impairment after breast cancer therapy

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2025年12月19日

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Destina Gizem Aydemir,
Isabel Molwitz,
Antonia Beitzen-Heineke,
Hang Chen,
Mathias Meyer,
Volkmar Müller,
Gerhard Adam,
Ersin Cavus,
Enver Tahir,
Jennifer Erley

摘要

Objectives

To investigate breast cancer therapy-related myocardial cardiotoxicity by analyzing right ventricular (RV), left atrial (LA), and right atrial (RA) function using cardiovascular magnetic resonance feature tracking (CMR-FT).

Materials and methods

This prospective single-center study involved 38 female breast cancer patients with a mean age of 50 ± 11 years, who received systemic anthracycline chemotherapy. CMR was performed in all patients before initiating therapy (at baseline (BL)) and after a 12-month follow-up (FU). FT was utilized to evaluate the RV global longitudinal (GLS), radial (GRS), and circumferential strain (GCS), as well as the biatrial reservoir, booster, and conduit strain. Paired t-tests were used to assess the differences in strain values from BL to FU.

Results

The mean RV GLS of all patients was significantly attenuated at FU compared to BL (−25.2 ± 3.9% at BL vs −20.6 ± 4.4% at FU, p < 0.001), whereas RV GRS and GCS showed no significant change. LA reservoir strain was significantly reduced at FU (24.1 ± 3.2 at BL vs 22.7 ± 3.3% at FU, p = 0.005), while LA booster and conduit strain showed non-significant change. Similarly, RA reservoir strain decreased significantly from BL to FU (24.9 ± 3.3% at BL vs 23.2 ± 2.9% at FU, p = 0.019), whereas RA booster and conduit strain did not significantly change from BL to FU.

Conclusions

Cancer therapy-related cardiac dysfunction (CTRCD) is not confined to the LV but affects the RV and the atria as well. Changes in RV GLS and LA/RA reservoir strain could serve as additional markers of subclinical cardiotoxicity in breast cancer patients.

Key Points

Question The role of RV and biatrial strain in detecting CTRCD is unclear.

Findings Biatrial reservoir strain and RV GLS were significantly attenuated after breast cancer therapy.

Clinical relevance RV GLS and biatrial reservoir strain might serve as early markers of subclinical cardiotoxicity after breast cancer therapy and should thus be routinely determined in patients with suspected CTRCD.

Graphical Abstract