Myocardial work – a new echocardiographic parameter for early detection and prediction of cardiotoxicity in Non-Hodgkin lymphoma patients

Scope: CHOP (cyclophosphamide, doxorubicin, oncovin, prednisone) is the standard chemotherapeutic regimen used in patients with non-Hodgkin lymphoma (NHL). Cardiotoxicity is the most feared side effect of chemotherapy, increasing morbidity and mortality. Aim. To define new parameters of LV myocardial work, arterial stiffness and biomarkers, for early diagnosis and prediction of cardiotoxicity.

Methods: 97 patients (44men, 58±11years), with NHL, with LVEF >50%, scheduled to receive CHOP, were assessed at baseline, after 3rdcycle and at the end of chemotherapy (doxorubicin cumulative dose 384±58mg). During mechanical systole and isovolumetric relaxation, 2D STE was used to calculate longitudinal strain (LS) and myocardial work: global constructive work (GCW) as the “positive” work of the heart; global wasted work (GWW) as the “negative” work of the heart; global work efficiency (GWE) by formula GCW/ (GCW+GWW) (%) and global work index (GWI), as the sum of GCW and GWW. EchotrackingAloka mea-suredpulse wave velocity (PWV), augmentation index (AIX) and β index. Troponin I and NTproBNP were measured as biomarkers of cardiac injury and high overload. Cardiotoxicity was defined as a decrease of 3D LVEF<50%, with more than 10% from the baseline value.

Results: After chemotherapy ended, 18 patients (18%) (group I) developed cardiotoxicity (3D LVEF=62±1 vs 48±1, p<0.0001), while 79 patients (group II) did not (3D LVEF=61±2 vs 57±1, p<0.0001). There was a significant reduction of LS, GCW and GWE, with increased GWW and arterial stiffness starting with the 3rd cycle, but group I had greater changes than group II (p<0.001). There were no significant changes of systolic and diastolic blood pressure. Univariate analysis showed a significant correlation between LVEF reduc-tion and the decrease of LS, GCW, GWE and increa-sed GWW, PWV, β index and troponin level after the 3rd cycle (r =0.53; r =0.64, r =0.41, r =-0.40, r= -0.36, r =-0.35, r=-0.33 respectively, all p<0.05). The reduction ofGCW after the 3rd cycle was the best independent predictor for LVEF decrease after CHOP therapy ended (R2=0.48, p=0.001). ROC analysis showed that a decre-ase of GCW with more than 27% after the 3rdcycle predicted with a Sb of 78% and Sp of 81% development of cardiotoxicity after chemotherapy ended.

Conclusions: Myocardial work is a new echocardiographic tool able to detect early chemotherapy-induced cardiotoxicity and to predict further decline of LVEF in patients with non-Hodgkin lymphoma. 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
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)