ABC | Volume 110, Nº3, March 2018

Original Article Kang et al Multi-layer strain analysis in lymphoma survivors Arq Bras Cardiol. 2018; 110(3):219-228 Table 1 – Clinical characteristics of two groups Normal Chemotherapy p value Number 27 42 Male (n/%) 12 (44.44) 18 (42.86) 0.84 Age (y) 50.39 ± 13.40 55.83 ± 17.92 0.16 Hypertension (n/%) 0(0) 4(9.52) ACEI (n/%) 0(0) 1(2.38) ARB (n/%) 0 (0) 1(2.38) CCB (n/%) 0(0) 0(0) β-blocker (n/%) 0(0) 1(2.38) Smoker (n/%) 5(17.24) 9(21.42) 0.470 DM (n/%) 0(0) 1(2.38) SBP (mmHg) 124.8 ± 12.6 121.6 ± 12.5 0.627 DBP (mmHg) 70.7 ± 9.3 69.5 ± 7.9 0.233 HR (bpm) 78.0 ± 11.3 81.0 ± 14.5 0.099 ACEI: angiotensin-converting enzyme inhibitors; ARB: angiotensin receptor blockers; CCB: calcium-channel blocker; DBP: diastolic blood pressure; DM: diabetes mellitus; HR: heart rate; SBP: systolic blood pressure; p values were assessed by independent samples t test Table 2 – Conventional echocardiographic parameters between two groups. Normal Chemotherapy p value LVEDV/BSA (ml) 47.22 ± 13.97 46.99 ± 13.99 0.95 LVESV/BSA (ml) 16.31 ± 6.24 16.30 ± 6.47 0.99 LVMI (g/m 2 ) 79.32 ± 16.66 71.87 ± 13.68 0.13 RWT 0.36 ± 0.05 0.36 ± 0.05 0.93 LVEF (%) 66.46 ± 5.55 66.04 ± 6.52 0.78 E velocity (m/s) 80.38 ± 24.11 72.45 ± 16.99 0.11 A velocity (m/s) 76.62 ± 17.76 76.61 ± 19.07 0.95 E/A ratio 1.11 ± 0.44 1.01 ± 3.53 0.32 S’ velocity (m/s) 9.50 ± 2.19 9.24 ± 2.08 0.60 E/E’ ratio 6.95 ± 3.21 6.71 ± 2.31 0.71 DT (ms) 145.88 ± 27.81 149.95 ± 34.28 0.61 IVRT (ms) 85.36 ± 20.14 88.13 ± 24.77 0.62 BSA: body surface area; DT: deceleration time; FS: fraction shortening; LVEDV: left ventricular end-diastolic volume; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume; LVMI: left ventricular mass index; IVRT: isovolumic relaxation time; RWT: relative wall thickness; p values were assessed by independent samples t test Multi-layer speckle tracking echocardiography In both groups, longitudinal and circumferential strains were highest in the apical region and decreased significantly from apical to basal level (Table 3,4). The left ventricular longitudinal and circumferential strains of different myocardial layers in patients and controls are shown in Table 5, Figure 1. Transmural strain gradients in LS and CS were demonstrated in both patients and controls, with strain values decreasing from the subendocardial to subepicardial layers. GCS was significantly decreased in chemotherapy group respect to control group (-27.73% ± 3.37% vs -24.94% ± 4.14%, p = 0.004). The reduction of GCS was attributable to significantly reduced CS-ENDO but preserved CS-EPI strain in patients compared with controls. The longitudinal strain values of global left ventricle and all three layers were significantly decreased in chemotherapy group. However, the two groups did not differ in transmural longitudinal strain gradient. In contrast, there was no statistic difference in radial strains between the two groups. There was no correlation between anthracycline dose and layer specific strain values. 221