P6893D echocardiography, arterial stiffness, and biomarkers for detection and prediction of late cardiotoxicity in non-Hodgkin lymphoma

Abstract

Abstract CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone) in non-Hodgkin lymphoma (NHL) is limited by risk of cardiotoxicity. Aim. To define new parameters to detect late cardiotoxicity. Methods 64 patients (27 men, 59±11 years) with NHL, scheduled for CHOP, with LVEF>50%, were assessed at baseline, after chemotherapy ended and 1 year later, by 3D echo for LVEF and deformation (longitudinal, radial, circumferential, area strain: LS, RS, CS, AS), by echo-tracking for pulse wave velocity (PWV) and wave intensity (WI), and by troponin I and NTproBNP. Cardiotoxicity was defined as LVEF decrease<50%, with >10% from baseline. Results 10 patients (group I) developed late cardiotoxicity, while 54 patients did not (group II). There was a reduction of LS, CS, AS, and increase of PWV and WI, with greater changes in group I (table). LVEF decrease correlated with LS, CS, AS, PWV, WI, troponin changes (r=0.57, r=0.37, r=0.41, r=−0.53, r=−0.43, r=−0.34 p<0.05). LS reduction after chemotherapy ended was the best independent predictor for LVEF decrease 1 year after therapy completion (R2=0.42 p=0.001). Decrease of LS >22% at the end of treatment predicted late cardiotoxicity with 85% sensitivity and 74% specificity. Late cardiovascular toxicity parametrs CHOP Group I Group II LS (-%) Baseline 22±2 21±2 Final 14±2† 18±2† After 1 year 11±1† 16±2† CS (-%) Baseline 21±2 21±2 Final 16±2† 19±2† After 1 year 13±2† 15±1† AS (%) Baseline 39±3 40±2 Final 33±2† 37±2† After 1 year 28±2† 35±1 PWV (m/s) Baseline 3.4±1.2 3.3±0.7 Final 6.9±1.5† 4.3±1.4† After 1 year 8.9±2.1† 5.5±1.3† WI (m/s) Baseline 4.2±0.8 4.4±0.6 Final 7.7±1.4† 5.1±0.8† After 1 year 9.4±0.9† 6.1±0.9† Abbreviations in text. †p<0.001. Conclusion Assessment of 3D myocardial deformation is able to detect late cardiovascular toxicity, and to predict further LVEF decline in NHL patients. Acknowledgement/Funding Grant PCCDI 83/2018 (BIOVEA)