Keramida Kalliopi, Farmakis Dimitrios
Cardio-oncology Clinic, Heart Failure Unit, Department of Cardiology, National and Kapodistrian University of Athens Medical School, Athens University Hospital Attikon, Athens, Greece.
University of Cyprus Medical School, Nicosia, Cyprus.
Heart Fail Rev. 2021 Sep;26(5):1189-1193. doi: 10.1007/s10741-020-09938-8.
The involvement of the right ventricle (RV) in various cardiovascular pathologies is usually explored and demonstrated after thorough research of the left ventricle (LV). This is also true in cardio-oncology, where multimodality imaging with cardiac magnetic resonance and nuclear imaging is essential, but echocardiography plays pivotal role in everyday clinical practice. Chemotherapy and radiotherapy effect on RV has been studied mainly in breast cancer patients and survivors from childhood cancer. Right ventricular geometry and shape limit the ability of classical echocardiographic indices like RV ejection fraction (RVEF), RV fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) to identify reliably subtle changes in RV systolic function in cancer patients. The assessment of diastolic function of the RV in various timepoints during or after chemotherapy leads to conflicting results too. However, longitudinal strain of the RV (RV LS) seems to detect myocardial injury with consistent results. Remarkably, cardiotoxicity of the RV is identified by RV LS almost simultaneously with LV cardiotoxicity and with similar cutoff percent change suggesting the uniform effect of cancer and its treatments on myocardium. The prognostic value of cardiotoxic effects on the RV needs to be investigated by large prospective studies.
在对左心室（LV）进行全面研究之后，通常会探究并证实右心室（RV）在各种心血管疾病中的参与情况。在心脏肿瘤学领域也是如此，心脏磁共振成像和核成像等多模态成像至关重要，但超声心动图在日常临床实践中发挥着关键作用。化疗和放疗对右心室的影响主要在乳腺癌患者以及儿童癌症幸存者中进行了研究。右心室的几何形状限制了诸如右心室射血分数（RVEF）、右心室面积变化分数（FAC）和三尖瓣环平面收缩期位移（TAPSE）等经典超声心动图指标可靠识别癌症患者右心室收缩功能细微变化的能力。在化疗期间或化疗后不同时间点对右心室舒张功能的评估也得出了相互矛盾的结果。然而，右心室纵向应变（RV LS）似乎能一致地检测到心肌损伤。值得注意的是，右心室心脏毒性几乎与左心室心脏毒性同时被RV LS识别出来，且截断百分比变化相似，这表明癌症及其治疗对心肌的影响是一致的。右心室心脏毒性作用的预后价值需要通过大型前瞻性研究来探究。
