Prognostic Implications of Left Ventricular Global Peak Systolic Longitudinal Strain in Lymphoma Patients Undergoing Anti-Cancer Therapy

Abstract

Background: Left ventricular (LV) global peak systolic longitudinal strain (GLS) detected by speckle-tracking echocardiography is a sensitive modality for detecting subclinical LV systolic dysfunction and a powerful prognostic predictor. However, the clinical implication of LV GLS in lymphoma patients receiving anti-cancer therapy remains unknown. Methods: We prospectively enrolled 74 lymphoma patients (57.9±17.0 years old, 57% male patients) having echocardiographic study before chemotherapy, after the 3 rd and 6 th chemotherapy cycles and 1 year after chemotherapy. A ≥15% reduction in absolute GLS value from baseline was defined as signifying cancer therapy–related cardiac dysfunction (CTRCD). After completing three cycles of anticancer therapy, cardiopulmonary exercise testing (CPET) was conducted. The primary outcome was defined as a composite of heart failure events and all-cause mortality. Findings: In 36 (49%) patients with CTRCD, LV GLS significantly decreased after the 3 rd cycle of chemotherapy (20.1±2.6% vs . 17.5±2.3%, p <0.001). In the multivariate analysis, we identified the male sex and anaemia (haemoglobin <11 g/dL) to be independent risk factors for CTRCD. Patients with CTRCD had lower minute oxygen consumption per kilogram (VO2/kg) and lower VO2/kg value at anaerobic threshold in CPET. The CTRCD group had a higher incidence of the primary composite outcome than did the non-CTRCD group (hazard ratio: 3.21, 95% confidence interval: 1.04–9.97, p =0.03). Interpretation: LV GLS can be used to detect early cardiac dysfunction in lymphoma patients receiving anti-cancer therapy. Patients with CTRCD had not only a reduced exercise capacity but higher risks of heart failure events and all-cause mortality. Funding Statement: National Cheng Kung University Hospital (NCKUH-10703039), the Ministry of Science and Technology, Taiwan (MOST 107-2314-B-006-078-MY3). Declaration of Interests: The authors stated that there are no competing financial interests in relation to this work. Ethics Approval Statement: The Human Research and Ethics Committee of National Cheng Kung University Hospital ratified this study (IRB numbers: A-ER-105-407 and B-ER-106-392). Written informed consent was provided by all the enrolled patients.