Early Changes in 2D-Speckle-Tracking Echocardiography May Predict a Decrease in Left Ventricular Ejection Fraction in Lymphoma Patients Undergoing Anthracycline Chemotherapy: A Pilot Study
Background: Two-dimensional speckle-tracking echocardiography (2D-STE) may detect early changes in cardiac mechanics in patients with normal left ventricular ejection fraction (LVEF). We aimed to evaluate whether changes in strain or strain rate, as measured by 2D-STE, precede a decrease in LVEF in patients with lymphoma undergoing anthracycline-based chemotherapy (AC).
Methods: We studied patients with lymphoma who underwent 2D-STE before and after starting AC. A cardiotoxicity “event” was defined as a decrease in LVEF by ≥10% or to <50%. Standard echocardiographic and strain indices were analyzed.
Results: A total of 46 patients with lymphoma (54% men; mean (SD) age, 64 (14) years) were included. An event occurred in 12 patients after starting AC. Abnormalities were detected in global longitudinal strain (GLS), peak systolic global longitudinal strain rate (GLSRs), and global circumferential strain rate (GCSR) at <6 months and in global longitudinal early diastolic strain rate (GLSRe) at 6-12 months before a decrease in LVEF (GLS odds ratio (OR) (95% CI) 1.86 (1.28-2.91), P<0.001; global circumferential strain OR (95% CI) 1.47(1.13-1.97), P=0.005; GLSRs OR (95% CI) 1.31 (1.10-1.61), P=0.002; and GCSR OR (95% CI) 1.08 (1.00-1.19), P=0.0495).
Conclusions: GLS and GLSRs were the earliest and most predictive echocardiographic strain parameters for AC-induced cardiomyopathy in this pilot study. These parameters may be incorporated into cardiotoxicity surveillance protocols for patients undergoing AC.