Speckle tracking echocardiography in the early detection and prediction of anthracycline cardiotoxicity in diffuse large B‐cell lymphoma treated with (R)‐CHOP regimen

Abstract

Background Despite speckle tracking echocardiography (STE) has emerged as a sensitive technique for identifying myocardial dysfunction, there are little data available on the appropriate timing to perform STE in the serial assessment after anthracycline administration. Moreover, further uncertainty is increased in the context of STE application in diffuse large B‐cell lymphoma (DLBCL) research, as most recommendations are inferred by studies conducted primarily in breast cancer. Objective This study aimed to determine whether early measurement of strain parameters derived by STE could predict the development of cardiotoxicity. Methods Sixty‐five patients were included in the final analysis. The patients were evaluated at baseline, after the third cycle and sixth‐eighth cycle, and during follow‐up. Global longitudinal strain (GLS) was analyzed using STE, and left ventricular ejection fraction (LVEF) was calculated by real time 3D echocardiography (RT3DE). Results There was a significant decrease in GLS after the third cycle of chemotherapy and remained decreased during subsequent follow‐up, whereas LVEF decreased only at follow‐up. A percentage reduction in GLS of 13.8% between baseline and the third cycle of chemotherapy was the best predictor of further LVEF reduction. Conclusion Earlier monitoring timing and more accurate assessment methods might be helpful in the prevention of irreversible heart failure.

Cardiac magnetic resonance assessment of right ventricular remodeling after anthracycline therapy

“…More recently, Barthur et al also investigated HER positive BC patients before, and serially after chemotherapy (6, 12, and 18 months), and showed adverse effects on RV structure and function that tended to recover after 18 months 15 . Recently Zhao et al 36 , reported in a cohort with large B-cell lymphoma, treated with anthracycline-based chemotherapy, that the RVEF decreased significantly from 54.0 ± 2.8% to 49.8 ± 2.4% ( P < 0.001), a change of a similar magnitude as in the present study.…”

“…Although criteria for RV cardiotoxicity are not well-defined or agreed upon, it has been proposed that significant reductions of RVEF below the lower limit of normal for the imaging method should be considered 36 . Since the lower normal limit of RVEF has been defined as 51% for women 28 , our findings highlight that even moderated exposure to anthracycline may cause a meaningful decline in RV function.…”

Analysis of Cardiac Adverse Reactions Caused by Different Doses of Adriamycin Chemotherapy in Patients with Breast Cancer

“…Adriamycin has been proved to be effective in chemotherapy for breast cancer patients and has gradually become the drug of choice in chemotherapy for breast cancer patients. It can not only destroy the protein and cell wall of tumor cells but also has an inhibitory effect on their DNA ligase, thus effectively inhibiting the growth of tumor cells [ 7 – 9 ]. However, its myelosuppression and cardiotoxicity should not be ignored, especially cardiotoxicity, which may lead to delayed progression, thus restricting the application of doxorubicins [ 10 , 11 ].…”

Analysis of left ventricular rotational deformation by 2D speckle tracking echocardiography: a feasibility study in athletes

“…The risk of potential malignant arrhythmias due to acute myocardits during competetive sport or in the presence of high responsibilities might justify the approaches to improve diagnostic tools like echocardiography which is widely available. A second diagnostic target of CS and LV rotation analysis by 2DSTE might be the early detection of cardiotoxic alterations in cancer patients during chemotherapy and of regional abnormalities of LV deformation due to granulomatous or storage diseases [43][44][45][46][47].…”