Diagnosis and prediction of late cardiovascular toxicity induced by RCHOP chemotherapy in non-Hodgkin lymphoma through 3D myocardial deformation, arterial stiffness and cardiac biomarkers

Introduction: RCHOP chemotherapy (rituximab, cy-clophosphamide, doxorubicin, vincristin, prednisone) in non-Hodgkin lymphoma (NHL) has a high risk of cardiotoxicity, with increased mortality.
Objective: To define new parameters of 3D LV defor-mation, arterial stiffness and biomarkers, for detection and prediction of late cardiovascular toxicity Methods: 55patients (31men, 57±10years), with NHL, with LVEF >50%, scheduled to receive RCHOP, were assessed at baseline, at the end of treatment and 9 months after treatment completion (doxorubicin cu-mulative dose 372±71mg). 3D echo (3DE) was used to assess LV EF and systolic deformation: longitudinal, radial, circumferential and area strain (LS, RS, CS, AS), Echo-Tracking Aloka to measure pulse wave velocity (PWV), augmentation index (AIX) and β index and troponin I and NTproBNP were measured as markers of cardiac injury and high overload, respectively. Car-diotoxicity was defined as a decrease of LVEF <50%, with more than 10% from the baseline value.
Results: 9 months after treatment completion, 12 patients (21%) (group I) developed cardiotoxicity (LVEF=62±3 vs 46±2, p<0.0001), while 43 patients (group II) did not (LVEF=62±2 vs. 58±2, p<0.0001). There was a significant reduction of all LV deformati-on parameters at the end of treatment and increased arterial stiffness, but group I had greater changes than group II (p<0.001). Univariate analysis showed a sig-nificant correlation between the LVEF reduction and the decrease of LS, CS, AS and increased PWV and β index after the final cycle of RCHOP (r=0.614; r=0.482, r=0.338, r=-0.488, r=-302, respectively, all p<0.05). The LS reduction at the end of chemotherapy was the best independent predictor for LVEF decrease 9 months af-ter treatment completion (R2=0.474, p=0.001). ROC analysis showed that a decrease of LS with more than 21% at the end of treatment predicted the occurence of cardiotoxicity 9 months after RCHOP-chemotherapy completion (Sb 82%, Sp 77%).
Conclusions: 3D myocardial deformation, arterial sti-ffness and cardiac biomarkers are essential to detect late chemotherapy-induced cardiotoxicity and to predict further decline of LVEF in patients with non-Hodgkin lymphoma, 9 months after chemotherapy completion. Further studies are needed to assess if these parameters can be used into routine clinical practice.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)