CMR Strain Analysis Reveals Right Ventricular and Biatrial Impairment Post Breast Cancer Treatment
Overview
This study demonstrates that breast cancer patients treated with anthracycline-based chemotherapy and radiotherapy exhibit significant myocardial impairment detectable by CMR feature tracking strain analysis. Notably, right ventricular and biatrial strain parameters showed longitudinal deterioration 13 months post-treatment, indicating subclinical cardiac dysfunction beyond left ventricular assessment.
Background
Breast cancer is the most commonly diagnosed cancer worldwide, with anthracycline chemotherapy remaining a cornerstone of treatment despite its known cardiotoxicity risks. Cancer therapy-related cardiac dysfunction (CTRCD) can lead to irreversible heart damage, necessitating early detection strategies. While left ventricular global longitudinal strain (GLS) is established for early cardiotoxicity detection, the impact on right ventricular (RV) and biatrial function is less understood. Cardiac magnetic resonance (CMR) imaging with feature tracking (FT) offers superior reproducibility and spatial resolution for myocardial strain assessment compared to echocardiography.
Data Highlights
Parameter
Baseline (BL)
Follow-up (FU)
Change
RV GLS
−21.5 ± 3.1%
−18.7 ± 3.5%
Significant decrease (p < 0.05)
RV GRS
35.2 ± 6.4%
30.1 ± 7.0%
Significant decrease (p < 0.05)
RV GCS
−18.3 ± 2.8%
−16.0 ± 3.1%
Significant decrease (p < 0.05)
LA Reservoir Strain (εs)
38.7 ± 6.2%
33.5 ± 5.8%
Significant decrease (p < 0.05)
LA Conduit Strain (εe)
−22.1 ± 4.5%
−18.3 ± 4.2%
Significant decrease (p < 0.05)
LA Booster Strain (εa)
−16.6 ± 3.7%
−15.2 ± 3.5%
Non-significant change
RA Reservoir Strain (εs)
40.2 ± 7.0%
35.0 ± 6.5%
Significant decrease (p < 0.05)
RA Conduit Strain (εe)
−23.0 ± 5.0%
−19.0 ± 4.7%
Significant decrease (p < 0.05)
RA Booster Strain (εa)
−17.2 ± 4.0%
−16.0 ± 3.8%
Non-significant change
Key Findings
Anthracycline-based chemotherapy and subsequent radiotherapy in breast cancer patients lead to significant reductions in right ventricular global longitudinal, radial, and circumferential strain at 13 months post-treatment.
Left and right atrial reservoir and conduit strain parameters significantly decreased after treatment, indicating impaired atrial function.
Booster pump strain of both atria showed no significant change, suggesting selective impairment of atrial phases.
CMR feature tracking provides sensitive detection of subclinical myocardial dysfunction beyond conventional left ventricular ejection fraction assessment.
Interobserver agreement for strain measurements was high, supporting the reproducibility of CMR-FT in this setting.
Clinical Implications
Early detection of subclinical myocardial impairment in breast cancer patients undergoing anthracycline chemotherapy and radiotherapy is critical to prevent progression to overt cardiomyopathy. Incorporating CMR-FT strain analysis of the right ventricle and biatrial function into routine cardiac monitoring protocols may enhance risk stratification and guide timely cardioprotective interventions. This approach complements left ventricular strain assessment and may identify patients at risk who would otherwise be missed by conventional imaging.
Conclusion
CMR feature tracking strain analysis reveals significant impairment of right ventricular and biatrial myocardial function following breast cancer treatment with anthracyclines and radiotherapy. These findings underscore the importance of comprehensive cardiac evaluation beyond left ventricular parameters to detect early cardiotoxicity.
References
Tahir et al 2024 -- CMR Strain Analysis of Right Ventricular and Biatrial Function Reveals Myocardial Impairment Following Breast Cancer Treatment
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