An echocardiographic study of right ventricular function and pulmonary systolic pressure in patients treated with anthracyclines

Background/Aim: Anthracycline-based chemotherapy agents are widely used and are highly effective, particularly for breast cancer treatment. Although the cardiotoxic effects of anthracyclines on left ventricular (LV) function are well established, their impact on right ventricular (RV) function has not been sufficiently investigated. This study aimed to evaluate the effects of anthracycline therapy on RV function and to compare them with LV function to determine the potential cardiotoxic effects on both ventricles. Materials and Methods This retrospective cohort study included 38 female breast cancer patients who received anthracycline therapy between January 2021 and June 2023 and underwent regular echocardiographic follow-up. Echocardiographic parameters and cardiac biomarkers were assessed at baseline (pre-treatment) and six months after the initiation of therapy. Tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio were measured to evaluate RV function. Serum troponin I and pro-brain natriuretic peptide (pro-BNP) levels were also recorded. The paired-samples t-test was used for statistical analysis, with a p-value < 0.05 considered statistically significant. Results Following anthracycline therapy, LV end-systolic diameter (LVESD) increased (2.76 ± 0.24 cm vs. 3.03 ± 0.29 cm, p < 0.001), and LV ejection fraction (LVEF) decreased (67.3 ± 3.6% vs. 62.2 ± 4.5%, p < 0.001). Early diastolic transmitral flow velocity (E wave) and mitral annular early diastolic velocity (e′) were reduced (E: 0.63 ± 0.16 m/s vs. 0.52 ± 0.12 m/s, p < 0.001; e′: 0.09 ± 0.03 m/s vs. 0.07 ± 0.02 m/s, p = 0.001). TAPSE decreased (2.28 ± 0.36 cm vs. 2.16 ± 0.27 cm, p = 0.047), and systolic pulmonary artery pressure showed a non-significant upward trend after treatment (p = 0.052).. The TAPSE/sPAP ratio declined (1.11 ± 0.47 vs. 0.86 ± 0.20, p < 0.001), and pulmonary artery diameter increased (19.9 ± 2.0 mm vs. 21.3 ± 2.6 mm, p = 0.008). Serum troponin I levels increased significantly (4.84 ± 1.25 ng/L vs. 11.93 ± 4.91 ng/L, p < 0.001). Conclusion Anthracycline therapy may adversely affect both LV and RV function. Changes in TAPSE, sPAP, and RV diastolic parameters suggest early right ventricular dysfunction. Routine evaluation of RV function, along with LV assessment, should be incorporated into cardiotoxicity monitoring during anthracycline-based chemotherapy.