Abstract:
Background: Patients treated for lymphoma are at risk of cardiovascular
adverse events. Global longitudinal strain (GLS) and global
circumferential strain (GCS) were
reported for predicting cardiovascular adverse events in patients
treated with doxorubicin. However, the prognostic value of RV ejection
fraction by 3D transthoracic echocardiography (3D TTE) have not been
elucidated yet. We hypothesized that RV echocardiography parameters
increases the sensitivity for predicting the later CAE.
Methods: In this retrospective study, ninety-six patients with diffuse
large B-cell lymphoma with normal cardiac function treated with R-CHOP
regimen were studied between January 2013 and January 2015 by 3D TTE.
Basic demographic data, oncology and echocardiography parameters were
measured. The main outcomes were the proportion of patients with grade
3–4 cardiovascular adverse events (CAE). The association of
pre-chemotherapy and post-chemotherapy echocardiography parameters with
CAEs was analyzed using proportional hazard analysis.
Results: Over a median follow-up period of 6.1 years (range, 4.9-7.6
years) after the completion of chemotherapy, 18 of 96 patients (19%)
experienced CAEs. Univariate predictors of CAE (P < .05) were
LVGLS, LVGCS, RVEF, and RVESV. Multivariate analysis of all significant
univariate variables showed that RVEF (hazard ratio, 0.848; 95%
confidence interval,0.785–0.916; P < .001) were significantly
and independently associated with CAE. Stepwise analysis of the
multivariate associations showed an increase in the global
x2 value after adding LVEF (P < .001) to
significant clinical variables.
Conclusion: LVGLS and RVEF were significantly and independently
associated with CAE in patients. Adding RVEF to other clinical variables
provided incremental prognostic information.
Keywords: LV function, RV function, 3-D echocardiography,
anthracycline cardiotoxicity, LV longitudinal strain, cardiovascular
adverse events