title: Assessment of right ventricular functions during cancer chemotherapy.
abstract: OBJECTIVE
  Although systolic and diastolic left ventricular functions after cancer chemotherapy are well studied, there are a few investigations about the right ventricular functions. We aimed to investigate the early effects of chemotherapy on right heart, if any, in addition to the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart echocardiographic indices.
  
  
  RESULTS
  Thirty-seven consecutive patients with newly diagnosed breast cancer who were planned to receive either AC protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2))] or CAF protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2)) + 5-fluorouracil (600 mg/m(2))] for six cures were enrolled between February 2009 and June 2010. Echocardiography was performed before the onset of the chemotheurapeutic regimen (T1), on the day after the completion of the first cure (T2), and after the completion of two cures of the regimen (T3). Serum NT-proBNP levels were also measured at T1, T2, and T3. The mean right ventricular fractional area change (RVFAC) was 63.7 ± 3.63, 63.3 ± 3.67, and 61.2 ± 4.41% at T1, T2, and T3, respectively (pT1-T3 and pT2-T3 <0.05). Tricuspid annular plane systolic excursion (TAPSE) has decreased in time (1.82 ± 0.2, 1.78 ± 0.19, and 1.62 ± 0.24 cm; pT1-T2, pT1-T3, and pT2-T3 were 0.002, <0.001, and <0.001, respectively). Tricuspid annular mean E'/A' ratios were 1.42 ± 0.16, 1.36 ± 0.18, and 1.11 ± 0.32 (pT1-T2 = 0.013, pT1-T3 < 0.001, and pT2-T3 < 0.001). Mean tricuspid annular systolic velocities were 11.35 ± 1.85, 11.0 ± 1.82, and 10.45 ± 1.75 cm/s for T1, T2, and T3; and the differences between T1 and T2, T1 and T3, and T2 and T3 were all significant (P = 0.005, <0.001, and 0.001). Median serum NT-proBNP levels were 82 (60-247), 116 (60-426), and 170 (60-600) pg/mL at T1, T2, and T3. The amount of change in RVFAC and TAPSE between T1 and T3 were found to be correlated with the amount of change in NT-proBNP measurements between T1 and T3 (R: -0.7, P < 0.001; R: -0.62, P < 0.001).
  
  
  CONCLUSIONS
  There is a subclinical decrease in right ventricular systolic and diastolic echocardiographic indices, although mostly, in the normal range, in a relatively short time interval after onset of chemotherapy.
authors: Department of Cardiology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey. aslitanindi@gmail.com
authors: Asli
authors: A
authors: Tanindi
authors: Umut
authors: U
authors: Demirci
authors: Gulten
authors: G
authors: Tacoy
authors: Suleyman
authors: S
authors: Buyukberber
authors: Yakup
authors: Y
authors: Alsancak
authors: Ugur
authors: U
authors: Coskun
authors: Ridvan
authors: R
authors: Yalcin
authors: Mustafa
authors: M
authors: Benekli
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D015150:Echocardiography, Doppler; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000139:chemically induced* / Q000000981:diagnostic imaging
chemical_list: D020097:Natriuretic Peptide, Brain; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil