title: The Early Predictive Value of Right Ventricular Strain in Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer.
abstract: BACKGROUND
  As cancer therapies have improved, patient life spans have been extended but quality of life has been threatened by chemotherapy induced cardiotoxicity. Most cardiac complications remain unobserved until specific symptoms develop. Speckle-tracking echocardiography is a sensitive imaging modality in detecting early occult myocardial dysfunction.
  
  
  METHODS
  A total number of 35 patients newly diagnosed with breast cancer and preparing for epirubicin therapy were prospectively recruited. Echocardiography, including speckle-tracking echocardiography, was performed sequentially at baseline (T1), after the first cycle (T2) and after the third cycle (T3) of epirubicin. At each visit, the severity of dyspnea was evaluated by the assessment scale.
  
  
  RESULTS
  Compared with the baseline, right ventricular longitudinal strain (RVLS_FW) at T2 significantly declined (-22.49 ± 4.97 vs. -18.48 ± 4.46, p = 0.001), which was also positively associated with the development of dyspnea (R2= 0.8, p = 0.01). At T3, both the left ventricular global longitudinal strain and RVLS_FW were significantly impaired (-21.4 ± 4.12 vs. -16.94 ± 6.81%; -22.49 ± 4.97 vs. -16.86 ± 7.27%, p = 0.01; 0.001, respectively). Also, the accumulating dose of epirubicin positively correlated with the development of dyspnea (R2= 0.38, p = 0.04) and the decline of RVLS_FW (R2= 0.53, p = 0.02). Notably, compared with the other echocardiographic parameters only RVLS_FW at the early stage (T2) significantly correlated with the development of dyspnea (odds ratio: 1.84, 95% confidence interval: 1.22-2.78, p = 0.04).
  
  
  CONCLUSIONS
  RVLS_FW sensitively predicts dyspnea development in breast cancer patients receiving epirubicin therapy. However, larger scale studies are required to validate its role in long-term patient survival.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center; ; Department of Biotechnology, Southern Taiwan University of Science and Technology.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center.
authors.forename: Jhih-Yuan
authors.initials: JY
authors.lastname: Shih
authors.affiliation: Division of Oncology, Department of Internal Medicine.
authors.forename: Yin-Hsun
authors.initials: YH
authors.lastname: Feng
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center.
authors.forename: Chun-Yen
authors.initials: CY
authors.lastname: Chiang
authors.affiliation: Division of Oncology, Department of Internal Medicine.
authors.forename: Yu Hsuan
authors.initials: YH
authors.lastname: Kuo
authors.affiliation: Division of Oncology, Department of Internal Medicine.
authors.forename: Wei-Yu
authors.initials: WY
authors.lastname: Chen
authors.affiliation: Division of Oncology, Department of Internal Medicine.
authors.forename: Hong-Chang
authors.initials: HC
authors.lastname: Wu
authors.affiliation: Department of Medical Research, Chi Mei Medical Center.
authors.forename: Juei-Tang
authors.initials: JT
authors.lastname: Cheng
authors.affiliation: Department of Medical Research, Chi Mei Medical Center.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center; ; Department of Pharmacy, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
authors.forename: Zhih-Cherng
authors.initials: ZC
authors.lastname: Chen
keywords: Dyspnea; Epirubicin; Right ventricle; Speckle-tracking echocardiography