Right ventricular strain as a predictor of trastuzumab-induced chemotherapy-related cardiac dysfunction: A meta-analysis

Introduction: The survival rates of breast cancer patients have improved drastically in the past few decades due to advancements in anti-neoplastic drugs. Trastuzumab (TZ) chemotherapy is associated with left ventricular dysfunction leading to cardiotoxicity. Two-dimensional speckletracking echocardiography has demonstrated efficacy in predicting TZ-induced cardiotoxicity; however, its role in using right ventricular (RV) strain parameters remains unclear. Methods: A comprehensive literature search spanning major electronic databases was conducted to identify studies comparing pre- and post-TZ chemotherapy RV strain parameters. The outcomes of interest included RV global longitudinal strain (GLS) and RV free-wall longitudinal strain (FWLS). Mean differences (MD) with 95% confidence intervals (CI) were pooled using the inverse-variance random-effects model. Statistical significance was set at p<0.05. Results: Four studies involving 275 cancer patients were included. The mean age of the patients was 53.35 +/- 11.1 years. The pooled analysis demonstrated significantly reduced RV GLS [MD: -1.94; 95% CI: -2.83, -1.05; p<0.01] and RV FWLS [MD: -2.05; 95% CI: -3.61, -0.50; p<0.01] on follow-up post-TZ chemotherapy compared to pre-TZ baseline values. Conclusion: Following TZ-based chemotherapy, RV subclinical damage ensues without overt clinical signs, leading to the deformation of RV mechanics. This meta-analysis demonstrated a reduction in RV GLS and RV FWLS after TZ-based chemotherapy.