title: The influence of chemotherapy on the right ventricle: did we forget something?
abstract: BACKGROUND
  A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy-induced right ventricular (RV) remodeling and summarize clinical studies on this topic.
  
  
  OBJECTIVE
  Chemotherapy induces RV structural, functional, and mechanical changes.
  
  
  METHODS
  We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword "chemotherapy," "heart," "right ventricle," "anthracyclines," and "trastuzumab."
  
  
  RESULTS
  The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy-induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment.
  
  
  CONCLUSIONS
  Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.
authors.affiliation: Cardiology department, University Clinical Hospital Centre "Dr. Dragisa Misovic", Belgrade, Serbia.
authors.forename: Marijana
authors.identifier: http://orcid.org/0000-0002-6235-5152
authors.initials: M
authors.lastname: Tadic
authors.affiliation: Clinical Research Unit, University of Milan-Bicocca and Italian Institute for Auxology, Meda, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.affiliation: Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth, Hospital Unit, The University of Western Australia, Perth, Australia.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Hering
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Lucia
authors.initials: L
authors.lastname: Venneri
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Danylenko
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003971:Diastole; D004452:Echocardiography / Q000379:methods; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D013318:Stroke Volume; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents
keywords: cancer; chemotherapy; right ventricle