Left ventricular response to short exercise in long term non-hodgkin lymphoma survivors

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Echocardiographic left ventricular (LV) global longitudinal strain (GLS) may be used to detect subclinical ventricular dysfunction in patients who have received cardiotoxic chemotherapy. However, in some persons participating in recreational sports, GLS at rest may be lower than normal, but normalizes after a short exercise test as soon as resting heart rate (HR) is reached. The aim of the study was to determine GLS response to a short exercise test in patients treated for aggressive non- Hodgkin Lymphoma (NHL) compared to controls. Methods We conducted a cross-sectional study nested in a cohort of NHL survivors and their siblings served as controls . Survivors were treated 5 years ago or longer with a cumulative doxorubicin (anthracycline) dose of at least 250 mg/m2. Transthoracic Echocardiography (TTE) was performed according to the guidelines. First, GLS and LV ejection fraction (EF) were measured at rest. After 20 squats, GLS and EF measurements were repeated when the HR was comparable to the HR during rest measurements. Results In total 20 survivors (mean age 49 (± 13) years, 11 men (55%) were included and measurements were compared to 14 controls. (mean age 45 (± 8) years, 8 men ( 57 %). In patients at rest, the EF was 52.6% ( ± 8.0%) and the GLS −16.1% ( ± 2.9%), compared to controls with an EF of 56.2% (± 3.4% ) (p-value 0.13) and GLS −18.0% (± 1.4 %) (p-value 0.031). All patients performed 20 squats and their EF increased to 55.0% (± 6.8%) and GLS −18.7% (± 3.8%) compared to controls in whom the EF increased to 62% (± 4.7%) (p-value 0.002) and GLS −21.3% (± 2.5%) (p-value 0.037) (Figure 1). Conclusion In addition to GLS measurement at rest, GLS after a short exercise test seems to be a promising tool to detect subclinical LV dysfunction in non-Hodgkin Lymphoma survivors. Further research in larger studies is needed to confirm these findings and to assess the association with clinical parameters.