3D echocardiography, arterial stiffness, and biomarkers in early diagnosis and prediction of CHOP-induced cardiotoxicity in non-Hodgkin\u2019s lymphoma

Diana Mihalcea,Ana-Maria Vladareanu,Natalia Patrascu,Ramona Bruja,Dragos Vinereanu,Maria Florescu

doi:10.1038/s41598-020-75043-3

Abstract

CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) represents standard chemotherapy in non-Hodgkin's lymphoma (NHL) with risk of cardiotoxicity. To define new parameters, such as 3D myocardial deformation, arterial stiffness, and biomarkers for early diagnosis and prediction of cardiotoxicity. 110 NHL patients with LVEF > 50%, scheduled for CHOP, were evaluated at baseline, after third cycle and chemotherapy completion. 3DE assessed LVEF and myocardial deformation: longitudinal (LS), radial, circumferential, area strain. Echo-tracking analysed arterial stiffness: PWV, β index, wave intensity. Troponin I and NT-pro-BNP were measured. After chemotherapy completion, 18 patients (16%) (group I) developed cardiotoxicity (LVEF decrease < 50%, with > 10% from baseline); 92 patients (group II) did not. Significant reduction of 3D LV deformation and increase of arterial stiffness developed starting with third cycle, with greater changes in group I. LS reduction and PWV increase after third cycle were the best independent predictors for LVEF decrease; the association of LS decrease by > 19% and PWV increase by > 27% after third cycle predicted cardiotoxicity after chemotherapy completion (90% sensitivity and 81% specificity). 3D LS and PWV can detect early chemotherapy-induced cardiotoxicity and predict LVEF decline. These parameters should be incorporated in clinical protocols to monitor cardiovascular function during chemotherapy and early intervention.

Highlights

CHOP represents standard chemotherapy in non-Hodgkin’s lymphoma (NHL) with risk of cardiotoxicity
Baseline characteristics. 110 patients were included in the study: 18 patients (16%) developed cardiotoxicity at the end of CHOP chemotherapy, whereas 92 subjects (84%) did not
Baseline 3D left ventricular ejection fraction (LVEF) was 62 ± 2%, with no differences between groups; after third cycle of chemotherapy, there was a decrease of 3D LVEF in the study group, with significant difference between the two groups, which persisted after treatment completion (Fig. 1). 3D myocardial deformation parameters were similar at baseline between groups

Summary

Introduction

CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) represents standard chemotherapy in non-Hodgkin’s lymphoma (NHL) with risk of cardiotoxicity. To define new parameters, such as 3D myocardial deformation, arterial stiffness, and biomarkers for early diagnosis and prediction of cardiotoxicity. NHL Non-Hodgkin’s lymphoma NT pro-BNP N-terminal pro-brain natriuretic peptide PWV Pulse wave velocity ROC Receiver operating curve RS Radial strain SD Standard deviation Tn I Troponin I WI Wave intensity. Description of new and simple parameters of myocardial deformation and arterial stiffness, affected before decrease of LVEF, might diagnose subclinical, early changes of cardiac function induced by CHOP therapy, and might be able to predict cardiotoxicity[5,6]. Our aim was to define new parameters, such as 3D myocardial deformation, arterial stiffness, and biomarkers, in early detection and prediction of cardiovascular toxicity, in NHL patients receiving CHOP chemotherapy

Objectives

Methods

Results

Conclusion