Study Subjects
This study was approved by the Fudan University Shanghai Cancer Center (1212117-6) and Zhongshan Hospital Research Ethics Committee. We identified 149 consecutive patients with pathologically confirmed diffuse large B-cell lymphoma at Fudan University Shanghai Cancer Center who underwent echocardiography with strain measurements between January 2013 and January 2015. All patients received 4-8 cycles of R-CHOP therapy (cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 up to a maximum dose of 2 mg/m2; doxorubicin 50 to 70 mg/m2 on day 1; prednisone 100 mg on days 1 to 5; and rituximab 375 mg/m2 every 21 days). We excluded patients with uncontrolled hypertension (n=1), renal or hepatic dysfunction(n=1), significant valvular disease (n=2), congenital disease(1), a widened QRS complex on surface ECG(n=1), arrhythmia (n=4), a previous history of heart failure and/or CAD (n=1) and noncardiac death (malignancy or complication linked to malignancy, n=25), patients with overall poorly tracking strain studies (n=17). The study population thus comprised 96 identified patients who underwent echocardiography examination before the commencement of chemotherapy and after the completion of chemotherapy (Figure 1).