Evaluation of Tricuspid Annular Plane Systolic Excursion (TAPSE) in cancer patients undergoing anthracycline-based therapy: A pre–post study

Zaras Yudhistira Saga; Tutik Harjianti; Pendrik Tandean; Syakib Bakri; Himawan Sanusi; Arifin Seweng

doi:10.23750/abm.2026.18443

Evaluation of Tricuspid Annular Plane Systolic Excursion (TAPSE) in cancer patients undergoing anthracycline-based therapy: A pre–post study

Authors

Zaras Yudhistira Saga Department of Internal Medicine, Faculty of Medicine Hasanuddin University, Indonesia https://orcid.org/0009-0003-0602-2673
Tutik Harjianti Hematology and Clinical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Indonesia https://orcid.org/0000-0002-9731-5193
Pendrik Tandean Cardiovascular Division, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Indonesia https://orcid.org/0000-0002-6600-4763
Syakib Bakri Nephrology and Hypertension Division, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Indonesia https://orcid.org/0000-0002-6615-5166
Himawan Sanusi Endocrine and Metabolic Diseases Division, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Indonesia https://orcid.org/0000-0003-3828-2958
Arifin Seweng Department of Public Health, Faculty of Medicine Hasanuddin University, Indonesia. https://orcid.org/0000-0003-0853-7809

Keywords:

Anthracyclines, Tricuspid Annular Plane Systolic Excursion (TAPSE), Right Ventricular Dysfunction, Cardiotoxicity, Non-invasive Monitoring

Abstract

Introduction: Anthracycline-based chemotherapy is effective in treating various cancers but is known for dose-dependent cardiotoxicity, typically affecting the left ventricle (LV). Recent studies have suggested that the right ventricle (RV) may also be impacted. Tricuspid Annular Plane Systolic Excursion (TAPSE) is a non-invasive echocardiographic tool that assesses RV systolic function. This study aims to evaluate the effects of anthracycline chemotherapy on TAPSE and explore its correlation with LV ejection fraction (LVEF).

Aim: To investigate the impact of anthracycline chemotherapy on RV function using TAPSE and to assess the relationship between changes in TAPSE and LVEF in cancer patients.

Methods: This pre-post observational study included 74 cancer patients receiving anthracycline-based chemotherapy, specifically, Doxorubicin, at Wahidin Sudirohusodo General Hospital. Echocardiographic measurements of TAPSE and LVEF were performed before and after chemotherapy. Statistical analyses included Mann–Whitney, Wilcoxon signed-rank, and Kruskal–Wallis tests to evaluate changes in TAPSE and LVEF.

Results: After chemotherapy, 79.7% of patients showed a significant decrease in TAPSE (mean reduction: 2.2 mm, p = 0.001). TAPSE decreased from 20.8 ± 2.3 mm pre-treatment to 18.6 ± 2.7 mm post-treatment. A significant positive correlation was found between changes in TAPSE and LVEF (r = 0.62, p = 0.001).

Conclusions: Anthracycline chemotherapy leads to significant RV dysfunction, as indicated by reduced TAPSE, which correlates with LV dysfunction. TAPSE is a valuable tool for early detection of biventricular cardiotoxicity in cancer patients undergoing anthracycline treatment.

References

1. Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63(25 Pt A):2751-68. doi: 10.1016/j.jacc.2014.01.073

2. Rossetto L, Di Lisi D, Madaudo C, et al. Right ventricle involvement in patients with breast cancer treated with chemotherapy. Cardio-Oncology. 2024;10:24. doi: 10.1186/s40959-024-00224-2

3. McLaughlin ES, Travers C, Border WL, Deshpande S, Sachdeva R. Tricuspid annular plane systolic excursion as a marker of right ventricular dysfunction in pediatric patients with dilated cardiomyopathy. Echocardiography. 2017;34(1):102-7. doi: 10.1111/echo.13416

4. Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy. Eur Heart J Cardiovasc Imaging. 2014;15(10):1063-93. doi: 10.1093/ehjci/jeu077

5. Attia A, Kamal H, Merry M, Mahmoud I. Right ventricle function evaluation by 2D transthoracic-echocardiography in breast cancer patients undergoing anthracycline chemotherapy, a prospective cohort study. The Egyptian Journal of Hospital Medicine. 2023;91:4975-8. doi: 10.21608/ejhm.2023.301775

6. Kariyanna P, Kumar A, Jayarangaiah A, et al. Chemotherapy-induced right ventricular cardiomyopathy: a systematic review and meta-analysis. Front Cardiovasc Med. 2023;10. doi: 10.3389/fcvm.2023.1103941

7. Faggiano A, Gherbesi E, Giordano C, et al. Anthracycline-induced subclinical right ventricular dysfunction in breast cancer patients: a systematic review and meta-analysis. Cancers (Basel). 2024;16(22):3883. doi: 10.3390/cancers16223883

8. Chang WT, Shih JY, Feng YH, et al. The early predictive value of right ventricular strain in epirubicin-induced cardiotoxicity in patients with breast cancer. Acta Cardiol Sin. 2016;32(5):550-9. doi: 10.6515/acs20151023a

9. Mohammadi K, Gertasi M, Raeisi M, Bodagh H, Parizad R, Yosefzadeh A. Right ventricular echocardiographic function in patients with breast cancer undergoing anthracycline-based chemotherapy: a prospective study. Caspian J Intern Med. 2025;16(2):347-54. doi: 10.22088/cjim.16.2.347