Abstract 18966: Right Ventricular Dysfunction is Common in Patients With Breast Cancer Experiencing Cardiotoxicity During Adjuvant Trastuzumab Therapy
Bibliographic record
Abstract
Background: Cardiotoxicity (CTOX) during cancer chemotherapy is commonly identified using a threshold reduction in left ventricular ejection fraction (LVEF) from pre-therapy values. Right ventricular (RV) dysfunction is not considered in the definition of CTOX. We examined the hypothesis that RV dysfunction will be present in a subset of patients experiencing CTOX. Methods: We retrospectively analyzed echocardiograms (echo) performed in consecutive breast cancer patients referred to a heart function clinic for management of CTOX during adjuvant trastuzumab therapy. All patients had an echo performed during the first clinical visit and were not on cardio-protective therapy. RV function was assessed using fractional area change (FAC) and global longitudinal peak systolic strain (VVI software, Siemens, Figure) using a 4 chamber view. Ten healthy volunteers were used as controls for RV strain measurements. Results: A total of 27 female pts (age 53 ± 12yrs) were included. Mean 2D biplane LVEF was 53.5 ± 9.3% with 13/27 having an LVEF <55%. The mean RV FAC for all patients was 39.6 ± 9.0%, with 7/27 (26%) having an abnormal FAC (<35%). LVEF was normal in 4 of these 7 patients. Including all 6 RV segments mean RV global longitudinal strain was -17.1 ± 7.4% versus -25.4 ± 2.2% in controls (p=0.001). Limiting the analysis to the 3 RV lateral wall segments, the mean longitudinal strain in patients was -22.9 ± 3.6% versus -30.0 ± 3.3% in controls (p=0.007). Using a strain cut off value of -23.5% for the lateral wall (2SD below mean for normal), 9/20 (45%) with normal FAC had had abnormal RV peak systolic longitudinal strain. Conclusion: Amongst patients referred for management of CTOX, 26% had significant RV systolic dysfunction. However, and additional 45% of the patients had subclinical RV dysfunction based on a reduced RV longitudinal strain. RV dysfunction should be considered as an important parameter in the assessment of patients referred for the assessment of cardiotoxicity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".