{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T23:20:03Z","timestamp":1794007203808,"version":"4.8.0"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The right ventricle has been considered by many clinicians to be the \u201cforgotten chamber\u201d of the heart. In this narrative review of the literature, we aim to examine chemotherapy-induced right ventricular failure. We will discuss the clinical significance of the subject, the effects of chemotherapy on the heart, and why it is crucial to take a closer look at the right ventricle. We will present key aspects of the anatomy and physiology of the right ventricle and how it differs from the left ventricle. Furthermore, this review explains the mechanisms behind chemotherapy-induced right ventricular dysfunction, strategies for assessing the right ventricle, recent advancements in cardiac imaging, available treatment options, and future directions in therapeutic management.<\/jats:p>","DOI":"10.3390\/medicina62091619","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T08:03:41Z","timestamp":1787558621000},"page":"1619","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Chemotherapy-Induced Right Ventricular Dysfunction"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9065-1745","authenticated-orcid":false,"given":"Camil-Horia-Eusebiu","family":"Cri\u0219an","sequence":"first","affiliation":[{"name":"4th Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Internal Medicine, Satu Mare Emergency County Hospital, 440192 Satu Mare, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9407-2261","authenticated-orcid":false,"given":"Anca-Daniela","family":"F\u0103rca\u0219","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Cardiology, Cluj Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5152-6040","authenticated-orcid":false,"given":"Andrada-Viorica","family":"P\u00e2rvu","sequence":"additional","affiliation":[{"name":"10th Department of Oncology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Hematology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Oncology Institute Cluj-Napoca, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela-Anca","family":"Stoia","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Cardiology, Cluj Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin-Petru","family":"Anton","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Cardiology, Cluj Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3989-2291","authenticated-orcid":false,"given":"Angela","family":"Cozma","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Internal Medicine, \u201cC\u0103ile Ferrite\u201d Hospital Cluj-Napoca, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.clon.2014.10.004","article-title":"Estimation of an Optimal Chemotherapy Utilisation Rate for Cancer: Setting an Evidence-based Benchmark for Quality Cancer Care","volume":"27","author":"Jacob","year":"2015","journal-title":"Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Trapani, D., Zagami, P., Nicol\u00f2, E., Pravettoni, G., and Curigliano, G. (2020). Management of Cardiac Toxicity Induced by Chemotherapy. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092885"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","article-title":"2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"47","DOI":"10.7326\/0003-4819-125-1-199607010-00008","article-title":"Anthracycline-Induced Cardiotoxicity","volume":"125","author":"Shan","year":"1996","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.hfc.2011.03.001","article-title":"A Historical Perspective of Anthracycline Cardiotoxicity","volume":"7","author":"Ewer","year":"2011","journal-title":"Heart Fail. Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40959-020-00079-3","article-title":"Early- and late anthracycline-induced cardiac dysfunction: Echocardiographic characterization and response to heart failure therapy","volume":"6","author":"Kamphuis","year":"2020","journal-title":"Cardio-Oncology"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mincu, R.I., Lampe, L.F., Mahabadi, A.A., Kimmig, R., Rassaf, T., and Totzeck, M. (2021). Left Ventricular Diastolic Function Following Anthracycline-Based Chemotherapy in Patients with Breast Cancer without Previous Cardiac Disease\u2014A Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10173890"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1080\/08998280.2013.11929018","article-title":"The Myth of the Bernheim Syndrome","volume":"26","author":"Chung","year":"2013","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s10554-015-0598-x","article-title":"Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension","volume":"31","author":"Motoji","year":"2015","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_10","first-page":"73","article-title":"The Right Ventricle: Biologic Insights and Response to Disease: Updated","volume":"9","author":"Walker","year":"2013","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"289","DOI":"10.2459\/JCM.0b013e32834eacf0","article-title":"Relation between right and left ventricular function in patients undergoing chronic dialysis","volume":"14","author":"Paneni","year":"2013","journal-title":"J. Cardiovasc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Petit, M., and Vieillard-Baron, A. (2023). Ventricular interdependence in critically ill patients: From physiology to bedside. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1232340"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vijiiac, A., Onciul, S., Guzu, C., Scarlatescu, A., Petre, I., Zamfir, D., Onut, R., Deaconu, S., and Dorobantu, M. (2021). Forgotten No More\u2014The Role of Right Ventricular Dysfunction in Heart Failure with Reduced Ejection Fraction: An Echocardiographic Perspective. Diagnostics, 11.","DOI":"10.3390\/diagnostics11030548"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2648","DOI":"10.1161\/ATVBAHA.121.316697","article-title":"Cardiotoxicity of Cancer Treatments: Focus on Anthracycline Cardiomyopathy","volume":"41","author":"Nishi","year":"2021","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100909","DOI":"10.1016\/j.cpcardiol.2021.100909","article-title":"Anthracycline Associated Disturbances of Cardiovascular Homeostasis","volume":"47","author":"Avagimyan","year":"2022","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1007\/s10741-020-09982-4","article-title":"Right ventricular phenotype, function, and failure: A journey from evolution to clinics","volume":"26","author":"Taverne","year":"2021","journal-title":"Heart Fail. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"L715","DOI":"10.1152\/ajplung.00583.2020","article-title":"Right ventricular pressure-volume loop shape and systolic pressure change in pulmonary hypertension","volume":"320","author":"Richter","year":"2021","journal-title":"Am. J. Physiol. Lung Cell. Mol. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"R26","DOI":"10.1530\/ERP-18-0051","article-title":"Tricuspid regurgitation and the right ventricle in risk stratification and timing of intervention","volume":"6","author":"Rana","year":"2019","journal-title":"Echo Res. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Faggiano, A., Gherbesi, E., Giordano, C., Gamberini, G., Vicenzi, M., Cuspidi, C., Carugo, S., Cipolla, C.M., and Cardinale, D.M. (2024). Anthracycline-Induced Subclinical Right Ventricular Dysfunction in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Cancers, 16.","DOI":"10.3390\/cancers16223883"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1002\/clc.22672","article-title":"The influence of chemotherapy on the right ventricle: Did we forget something?","volume":"40","author":"Tadic","year":"2017","journal-title":"Clin. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e811","DOI":"10.1161\/CIR.0000000000001056","article-title":"Cardio-Oncology Drug Interactions: A Scientific Statement From the American Heart Association","volume":"145","author":"Beavers","year":"2022","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1161\/CIR.0000000000000426","article-title":"Drugs That May Cause or Exacerbate Heart Failure","volume":"134","author":"Page","year":"2016","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"609194","DOI":"10.1155\/2015\/609194","article-title":"Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy","volume":"2015","author":"Calleja","year":"2015","journal-title":"J. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Vuong, J.T., Stein-Merlob, A.F., Cheng, R.K., and Yang, E.H. (2022). Novel Therapeutics for Anthracycline Induced Cardiotoxicity. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.863314"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Theetha Kariyanna, P., Kumar, A., Jayarangaiah, A., Shetty, M., Chowdhury, Y., Das, S., and Jayarangaiah, A. (2023). Chemotherapy induced right ventricular cardiomyopathy; a systematic review and meta-analysis. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1103941"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Torre, D.E., and Pirri, C. (2025). Right Heart Failure in Critical and Chronic Care: Current Concepts, Challenges and Mechanical Support Strategies. Med. Sci., 13.","DOI":"10.3390\/medsci13040210"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/bcp.13508","article-title":"Dasatinib-induced pulmonary arterial hypertension","volume":"84","year":"2018","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1183\/09031936.00154210","article-title":"Fully reversible pulmonary arterial hypertension associated with dasatinib treatment for chronic myeloid leukaemia","volume":"38","author":"Dumitrescu","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.cardfail.2024.08.045","article-title":"Cardio-Oncology and Heart Failure: A Scientific Statement From the Heart Failure Society of America","volume":"31","author":"Bloom","year":"2025","journal-title":"J. Card. Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1590\/0100-3984.2017.0160","article-title":"Pulmonary thromboembolism and coronary thrombosis after chemotherapy with cisplatin: Simultaneous diagnosis with non-ECG gated computed tomography","volume":"52","author":"May","year":"2019","journal-title":"Radiol. Bras."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40959-020-00066-8","article-title":"Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction","volume":"6","author":"Planek","year":"2020","journal-title":"Cardio-Oncology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2910","DOI":"10.1053\/j.jvca.2025.07.021","article-title":"2025 ASE Guidelines on Echocardiographic Evaluation of the Right Heart with Focus on Pulmonary Hypertension: A Welcome and Necessary Update","volume":"39","author":"Cormican","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Pagnoni, G., Giuggioli, D., Darroudi, S., de Pinto, M., Maini, A., Spinella, A., Sandri, G., Pinti, M., Aschieri, D., and Baccarani, A. (2026). Reproducibility of Echocardiographic Measurements of Right Ventricular Function: Comparison Between TAPSE and TDI S\u2032. J. Cardiovasc. Dev. Dis., 13.","DOI":"10.3390\/jcdd13030104"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"qyag004","DOI":"10.1093\/ehjimp\/qyag004","article-title":"Alterations of right ventricular assessment by use of an ultrasound-enhancing agent during routine visualization of the left ventricle","volume":"4","author":"Bhargav","year":"2026","journal-title":"Eur. Heart J.-Imaging Methods Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1016\/j.jacc.2022.08.743","article-title":"Advances in Multimodality Imaging in Cardio-Oncology","volume":"80","author":"Baldassarre","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.1038\/s41598-025-87272-5","article-title":"The importance of the Autostrain RV technique in the treatment of right ventricular myocardial alterations in patients with breast cancer receiving chemotherapy","volume":"15","author":"Liang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jcmg.2018.12.034","article-title":"Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction","volume":"13","author":"Obokata","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s10554-020-01953-y","article-title":"Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction","volume":"37","author":"Kanagala","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1042\/CS20200301","article-title":"Molecular mechanisms of anthracycline cardiovascular toxicity","volume":"135","author":"Narezkina","year":"2021","journal-title":"Clin. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1089\/ars.2020.8016","article-title":"Cardiac Damage in Anthracyclines Therapy: Focus on Oxidative Stress and Inflammation","volume":"32","author":"Rocca","year":"2020","journal-title":"Antioxid. Redox Signal."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1093\/cvr\/cvaa222","article-title":"Cardiac dysfunction in cancer patients: Beyond direct cardiomyocyte damage of anticancer drugs: Novel cardio-oncology insights from the joint 2019 meeting of the ESC Working Groups of Myocardial Function and Cellular Biology of the Heart","volume":"116","author":"Tocchetti","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1002\/ejhf.2721","article-title":"Right ventricular dysfunction in patients with new-onset heart failure: Longitudinal follow-up during guideline-directed medical therapy","volume":"24","author":"Gorter","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jchf.2025.02.007","article-title":"Management of Heart Failure With Improved Ejection Fraction","volume":"13","author":"Kodur","year":"2025","journal-title":"JACC Heart Fail."},{"key":"ref_44","first-page":"E895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1161\/CIRCULATIONAHA.109.883843","article-title":"Chronic Pulmonary Artery Pressure Elevation Is Insufficient to Explain Right Heart Failure","volume":"120","author":"Bogaard","year":"2009","journal-title":"Circulation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1183\/13993003.00090-2016","article-title":"Bisoprolol in idiopathic pulmonary arterial hypertension: An explorative study","volume":"48","author":"Allaart","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2045894019898030","DOI":"10.1177\/2045894019898030","article-title":"Spironolactone in pulmonary arterial hypertension: Results of a cross-over study","volume":"10","author":"Safdar","year":"2020","journal-title":"Pulm. Circ."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Qubbaj, F., Saeed, A., Younis, O., Al-Awamleh, N., Al-Sharif, Z., Shaban, Q., Sulaiman, S., and Turk, A. (2026). Efficacy of SGLT2 Inhibitors in Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis of Preclinical Studies. bioRxiv.","DOI":"10.64898\/2026.03.18.712480"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e013481","DOI":"10.1161\/CIRCHEARTFAILURE.125.013481","article-title":"Use of SGLT2 (Sodium-Glucose Cotransporter 2) Inhibitors in Pulmonary Hypertension","volume":"19","author":"Aguado","year":"2026","journal-title":"Circ. Heart Fail."},{"key":"ref_51","first-page":"CD014638","article-title":"Dexrazoxane for preventing or reducing cardiotoxicity in adults and children with cancer receiving anthracyclines","volume":"9","author":"Mulder","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1001\/jama.2023.11887","article-title":"Atorvastatin for Anthracycline-Associated Cardiac Dysfunction","volume":"330","author":"Neilan","year":"2023","journal-title":"JAMA"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.jacc.2013.09.040","article-title":"Increased Need for Right Ventricular Support in Patients With Chemotherapy-Induced Cardiomyopathy Undergoing Mechanical Circulatory Support","volume":"63","author":"Oliveira","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.21037\/cdt-20-592","article-title":"Emerging therapies for right ventricular dysfunction and failure","volume":"10","author":"Klinke","year":"2020","journal-title":"Cardiovasc. Diagn. Ther."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1619\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T08:36:24Z","timestamp":1787560584000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,22]]},"references-count":54,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091619"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091619","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,22]]}}}