Right Ventricular Ejection Fraction Assessed by Three-Dimensional Echocardiography Is Associated with Long-Term Adverse Clinical Cardiac Events in Patients with Anthracycline-Induced Cardiotoxicity - 01/06/22
Abstract |
Background |
Patients with cancer treated with chemotherapy are at risk for cardiovascular toxicity. Global longitudinal strain has been reported to play important roles in predicting cardiovascular adverse events (CAEs) in patients treated with anthracycline. In addition to various left ventricular indicators, the authors hypothesized that right ventricular (RV) parameters might be associated with CAEs related to anthracycline treatment.
Methods |
In this retrospective study, 96 patients diagnosed with diffuse large B-cell lymphoma who received chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab) were studied using three-dimensional transthoracic echocardiography. Baseline demographic data and oncologic and echocardiographic parameters were analyzed. The main outcome was the proportion of patients with grade 3 to 5 CAEs. The association of all three-dimensional transthoracic echocardiographic parameters with long-term CAEs was analyzed using Cox proportional-hazard analysis.
Results |
Over a median follow-up period of 6.1 years (range, 4.9-7.6 years) after the completion of anthracycline chemotherapy, 18 of 96 patients (19%) experienced CAEs. Percentage changes (%Δ) in left ventricular global longitudinal strain (LVGLS), global circumferential strain, RV ejection fraction (RVEF), and RV end-systolic volume were associated with CAEs (P < .05). A relative reduction of RVEF (hazard ratio, 0.847; 95% CI, 0.785-0.915; P < .001) was the strongest associated factor for CAEs. An increase in CAEs was also observed in patients with impaired %ΔLVGLS > 15% and impaired %ΔRVEF > 12.7% compared with those with impaired %ΔLVGLS > 15% and impaired %ΔRVEF < 12.7% (P = .032).
Conclusions |
Three-dimensional echocardiography–based assessments of %ΔRVEF and %Δ in RV end-systolic volume were significantly associated with CAEs in patients with lymphoma treated with anthracycline chemotherapy.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Decrease in RVEF during chemotherapy was associated with CAEs. |
• | Both %ΔRVEF and %ΔLVGLS by 3D TTE were strong identifiers of CAEs. |
• | %ΔRVEF provides incremental risk information to %ΔLVGLS for future CAEs. |
Keywords : RV function, 3D echocardiography, Anthracycline cardiotoxicity, Cardio-oncology, Cardiovascular adverse events
Abbreviations : 3D, CAE, GLS, LV, LVEF, LVGLS, %Δ, R-CHOP, RV, RVEF, TTE
Plan
| Drs Shen, H. Zhang, and Q. Zhang contributed equally to this study and should be considered joint first authors. |
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| This study was supported by the National Natural Science Foundation of China (grants 81771840 and 82170359), the Clinical Research Project of Zhongshan Hospital (grant 2020ZSLC21), and the Smart Medical Treatment Project of Zhongshan Hospital (grant 2020ZHZS16). |
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| Conflicts of interest: None. |
Vol 35 - N° 6
P. 600 - juin 2022 Retour au numéro
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