Volume 110, Nº 3, March 2018
DOI: http://www.dx.doi.org/10.5935/abc.20180042
ORIGINAL ARTICLE
Subclinical Anthracycline-Induced Cardiotoxicity in the Long Term Follow Up of Lymphoma Survivors: A Multi-Layer Speckle Tracking Analysis
Yu Kang
Fei Xiao
Haiyan Chen
Wei Wang
Lijing Shen
Hang Zhao
Xuedong Shen
Fangyuan Chen
Ben He
Figure 1 – Strain values between two groups. *:p < 0.05
Abstract
Background: Anthracycline generates progressive left ventricular dysfunction associated with a poor prognosis.
Objectives: The purpose of this study was to evaluate whether layer-specific strain analysis could assess the subclinical left ventricular dysfunction after exposure to anthracycline.
Methods: Forty-two anthracycline-treated survivors of large B-cell non-Hodgkin lymphoma, aged 55.83 ± 17.92 years (chemotherapy group) and 27 healthy volunteers, aged 51.39 ± 13.40 years (control group) were enrolled. The cumulative dose of epirubicin in chemotherapy group was 319.67 ± 71.71mg/m2. The time from last dose of epirubicin to the echocardiographic examination was 52.92 ± 22.32 months. Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), subendocardial, mid and subepicardial layer of longitudinal (LS-ENDO, LS-MID, LS-EPI) and circumferential strain (CS-ENDO, CS-MID, CS-EPI) values were analyzed. Transmural strain gradient was calculated as differences in peak systolic strain between the subendocardial and subepicardial layers. A value of p < 0.05 was considered significant.
Results: Conventional parameters of systolic and diastolic function showed no significant difference between two groups. Compared with controls, patients had significantly lower GCS and GLS. Multi-layer speckle tracking analysis showed significant reduction of circumferential strain of subendocardial layer, transmural CS gradient and longitudinal strain of all three layers. In contrast, the two groups did not differ in transmural longitudinal strain gradient and radial strains.
Conclusions: It proved the preferential impairment of subendocardial deformation in long-term survivors after exposure to anthracycline. Multi-layer speckle tracking echocardiography might facilitate the longitudinal follow-up of this at-risk patient cohort. (Arq Bras Cardiol. 2018; 110(3):219-228)
Keywords: Cardiotoxicity; Anthracyclines; Lymphoma, Non-Hodgkin; Hematologic Neoplasias/drug therapy; Echocardiography.
