Right ventricular dysfunction and mortality in breast cancer patients treated with anthracyclines: a retrospective cohort study

Abstract Introduction The use of anthracycline-based chemotherapy continues to be important in managing breast cancer, however, it does come with risks of heart-related complications. It is known that there is a left ventricular (LV) dysfunction, but right ventricle (RV) is also likely affected, albeit almost never looked at from a clinical perspective. Purpose To assess the changes in right ventricular function in female breast cancer patients with CTRCD and mortality from chemotherapy treatment, related to anthracycline chemotherapy sequelae. Methods This retrospective cohort study analyzed the data of 70 breast cancer patients treated with anthracycline-based chemotherapy at a single tertiary hospital from January 2024 to December 2024. Echocardiograms: RV global longitudinal strain (RVGLS), TAPSE, RV dimension, and right atrial area were used to measure all RV function before and after treatment. CT-RCD was determined by the drop of LV ejection fraction and/or global longitudinal strain. Results In a total of 32 patients (45.7%), CTRCD occurred. Compared with their counterparts with preserved RVGLS, patients with CT-RCD showed greater declines in RVGLS (mean ΔRVGLS = −2.9%, p < 0.001), lower post-treatment TAPSE (p = 0.01), and increased RA area (p < 0.05). ΔRVGLS was moderately correlated with ΔGLS (r = 0.49, p < 0.001). Of the patients, 17 (24.3%) died during follow-up, and the RV dysfunction parameters were significantly related to mortality (p < 0.05). Conclusion Right ventricular function significantly deteriorates after the administration of anthracycline chemotherapy and correlates with CTRCD and mortality. TAPSE and RVGLS could possibly work as indicators of early cardiotoxicity and risk evaluation in patients with breast cancer. These results promote integrated monitoring of the right ventricle in cardio-oncology schemes.Demographic and Clinical Characteristics Predictors of CTRCD and Mortality