Abstract
Objective: To investigate whether alterations of myocardial strain and high sensitive cardiac Troponin T (cTnT) could predict future cardiac dysfunction in patients after epirubicin exposure. Methods: Sixty-five patients aged 52.46±13.58 years with newly-diagnosed large B-cell non-Hodgkin lymphoma treated with epirubicin were studied. Blood collection and echocardiography were performed at baseline, 1 day after the third cycle, and 1 day after chemotherapy completion. After 4-6 months of chemotherapy, patients were studies using echocardiography. cTnT was detected with a highly sensitive assay. Longitudinal (LS), Circumferential (CS) and Radial Strain (RS) were calculated using two-dimensional speckle tracking echocardiography. Left Ventricular Ejection Fraction (LVEF) was analyzed by real-time 3D echocardiography. Cardiotoxicity was defined as a reduction of the Left Ventricular Ejection Fraction (LVEF) of ≥5% to <55% with symptoms of heart failure or an asymptomatic reduction of the LVEF of ≥10% to <55%. Results: LVEF remained stable and within normal limits in the whole course of chemotherapy, however decreased from 65.13±3.65% at baseline to 60.58±4.56% during follow-up (p=0.000). Twelve patients (18.46%) developed cardiotoxicity 4-6 months after treatment. Global LS (-18.56±1.69% vs -15.79±1.53%), CS (-20.88±2.67% vs -19.23±3.21%), RS (39.32±6.36% vs 34.79±6.15%) were markedly reduced and cTnT elevated from 0.0010±0.0020ng/ml to 0.0072±0.0035ng/ml (p all 15.9% decrease in longitudinal strain (sensitivity: 86%, specificity: 75%) and a >0.004ng/ml elevation in cTnT levels (sensitivity: 79%, specificity: 64%) from baseline to the third cycle of chemotherapy predicted later cardiotoxicity. Conclusions: Longitudinal strain combined with high sensitive cTnT may provide a reliable and non-invasive method to predict cardiac dysfunction in patients receiving anthracycline-based chemotherapy.
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