Aim: This meta-analysis aims to evaluate the impact of anthracycline chemotherapy on subclinical right ventricular (RV) dysfunction in breast cancer patients, using traditional echocardiographic parameters and strain-based measures, such as the RV global longitudinal strain (RV GLS) and the RV free-wall longitudinal strain (RV FWLS). Methods and Results: A systematic search was conducted according to PRISMA guidelines, including 15 studies with a total of 1148 breast cancer patients undergoing anthracycline chemotherapy. The primary outcome was the evaluation of changes in RV GLS and RV FWLS pre- and post-chemotherapy. Secondary outcomes included changes in traditional echocardiographic parameters: TAPSE, FAC, and TDI S’. Meta-analysis revealed significant declines in RV function post-chemotherapy across all parameters. RV GLS decreased from 23.99% to 20.35% (SMD: −0.259,p< 0.0001), and RV FWLS from 24.92% to 21.56% (SMD: −0.269,p< 0.0001). Traditional parameters like TAPSE, FAC, and TDI S’ also showed reductions, but these were less consistent across studies. A meta-regression analysis showed no significant relationship between post-chemotherapy left ventricular ejection fraction (LVEF) and the changes in RV GLS and RV FWLS, suggesting that RV dysfunction may not be solely a consequence of LV impairment. Conclusions: Anthracycline chemotherapy induces subclinical RV dysfunction in breast cancer patients. RV strain analysis, especially 3D strain, shows greater sensitivity in detecting early dysfunction. However, further research is needed to clarify the clinical significance and prognostic value of these findings, as well as the role of routine RV strain analysis in guiding early interventions.
目的：本荟萃分析旨在评估蒽环类化疗对乳腺癌患者亚临床右心室功能障碍的影响，采用传统超声心动图参数及基于应变的测量指标，如右心室整体纵向应变和右心室游离壁纵向应变。 方法与结果：根据PRISMA指南进行系统检索，共纳入15项研究，涉及1148例接受蒽环类化疗的乳腺癌患者。主要结局指标为化疗前后右心室整体纵向应变和右心室游离壁纵向应变的变化。次要结局指标包括传统超声心动图参数的变化：三尖瓣环收缩期位移、右心室面积变化分数及组织多普勒三尖瓣环收缩期峰值速度。荟萃分析显示，化疗后所有参数均提示右心室功能显著下降。右心室整体纵向应变从23.99%降至20.35%，右心室游离壁纵向应变从24.92%降至21.56。传统参数如三尖瓣环收缩期位移、右心室面积变化分数及组织多普勒三尖瓣环收缩期峰值速度亦呈下降趋势，但各研究间结果一致性较低。荟萃回归分析显示，化疗后左心室射血分数与右心室整体纵向应变及右心室游离壁纵向应变的变化无显著相关性，提示右心室功能障碍可能并非仅由左心室功能受损引起。 结论：蒽环类化疗可导致乳腺癌患者出现亚临床右心室功能障碍。右心室应变分析，尤其是三维应变技术，在早期功能障碍检测中表现出更高的敏感性。然而，仍需进一步研究以明确这些发现的临床意义及预后价值，并探讨常规右心室应变分析在指导早期干预中的作用。
肿瘤(癌症)患者之家