Assess Left Ventricular Systolic Function And Synchronicity Of Patients With Non-Hodgkin's Lymphoma Who Treated With Doxorubicin-Based Chemotherapy By Speckle Tracking Imaging

ObjectiveTo explore the value of two-dimensional and three-dimensional speckle tracking imaging(STI)in assessing the left ventricular systolic function and synchronicity of patients with non-Hodgkin's lymphoma(NHL)who treated with doxorubicin-based chemotherapy,we analyze the differences and correlations of left ventricular size,ejection fraction,systolic strain,and synchronicity parameters.MethodsFifty-two patients with both newly diagnosed non-Hodgkin's lymphoma confirmed by histopathology and normal two-dimensional left ventricular ejection fraction(2D LVEF>55%)were selected from People's Hospital of Zhengzhou University.All the cases were treated with CHOP or R-CHOP(doxorubicin-based chemotherapy).After the fourth cycle of chemotherapy,the cumulative doses of doxorubicin reached 200mg/m2.After the sixth to eighth cycles of chemotherapy,the cumulative doses of doxorubicin reached 300-400mg/m2.Two-dimensional echocardiography(2DE)and real-time three-dimensional echocardiography(RT-3DE)were carried out by GE Vivid E95 before chemotherapy,within two days after the fourth cycle,and within two days after the sixth to eighth cycles.EchoPAC was used to analyze average global longitudinal peak strain(GLPS Avg),layers strain,time to peak strain dispersion(PSD),global circumferential strain(GCS),three-dimensional left ventricular ejection fraction(3D LVEF),three-dimensional left ventricular global longitudinal strain(3D LVGLS)and three-dimensional left ventricular global circumferential strain(3D LVGCS).The differences in these parameters with the increase of the cumulative doses of doxorubicin were analyzed.The correlation between GLS and the increase of the cumulative doses of doxorubicin was analyzed.The correlation between PSD and the increase of the cumulative doses of doxorubicin was also analyzed.Results 1.Patients and cumulative doses of doxorubicin:In fifty-two NHL patients,aged 49.28±12.71 years old,four were withdrawn from the treatment with CHOP/R-CHOP after the third cycle,three were lost to follow-up,a total of forty-five patients(twenty-one CHOP cases and twenty-four R-CHOP cases)completed six to eight cycles were finally included in the statistical analysis.Forty-five patients completed four cycles(cumulative doses of doxorubicin over 200mg/m2),eleven patients completed six cycles(cumulative doses of doxorubicin over 300mg/m2),fifteen patients completed seven cycles(cumulative doses of doxorubicin over 350mg/m2),and nineteen patients completed eight cycles(cumulative doses of doxorubicin over 400mg/m2).Three patients were detected by two-dimensional echocardiography as definition of cancer therapeutics-related cardiac dysfunction(a decrease in the 2DE LVEF of >10 percentage points,to a value <53%).Forty-two patients completed the chemotherapy with a LVEF value >53%.2.LV size and function:Compared to the baseline(pre-chemotherapy),2D LVEF showed no significant differences during all cycles of chemotherapy(P>0.05).Compared to the baseline,3D LVEF showed no significant differences after the fourth cycle(P>0.05),but significantly reduced after the sixth to eighth cycles(P<0.05).3.Global strain:Compared to the baseline,GLPS Avg,3D LVGLS and 3D LVGCS significantly reduced after the fourth cycle and the sixth to eighth cycles(P<0.05).Compared to the fourth cycle,GLPS Avg,3D LVGLS and 3D LVGCS showed no significant differences after the sixth to eighth cycles(P>0.05).4.Longitudinal layers strain:GLPS AvgEndo > GLPS Avg > GLPS AvgEpi,the differences in three layers were significant from pre-chemotherapy to post-chemotherapy(P<0.01).Compared to the baseline,GLPS AvgEndo,GLPS Avg and GLPS AvgEpi all significantly reduced after the fourth cycle and the sixth to eighth cycles(P<0.01).Compared to the fourth cycle,GLPS AvgEndo,GLPS Avg and GLPS AvgEpi all showed no significant differences after the sixth to eighth cycles(P>0.05).5.Circumferential strain:SAX-MV GCS < SAX-PM GCS < SAX-AP GCS,there were no significant differences between SAX-PM GCS and SAX-MV GCS from pre-chemotherapy to post-chemotherapy(P>0.05),but significant differences between SAX-PM GCS and SAX-AP GCS from pre-chemotherapy to post-chemotherapy(P<0.01).Compared to the baseline,SAX-MV GCS,SAX-PM GCS and SAX-AP GCS showed no significant differences after the fourth cycle(P>0.05),but significantly reduced after the sixth to eighth cycles(P<0.01).Compared to the fourth cycle,SAX-MV GCS,SAX-PM GCS and SAX-AP GCS all showed no significant differences after the sixth to eighth cycles(P>0.05).6.Synchronicity:Compared to the baseline,PSD significantly increased after the fourth cycle(P<0.05)and the sixth to eighth cycles(P<0.01).Compared to the fourth cycle,PSD significantly increased after the sixth to eighth cycles(P<0.05).7.Correlation:Correlation analysis showed positive correlations of 3D LVGLS with cumulative doses of doxorubicin(r=0.526,P<0.01),and positive correlations of PSD with cumulative doses of doxorubicin(r=0.401,P<0.01).8.Receiver operating characteristic curve:The receiver operating characteristic(ROC)curve showed using GLPS Avg,PSD,3D LVGLS to determine the capability to discriminate between pre-chemotherapy and post-chemotherapy.In order of the area under the curve,3D LVGLS(0.845)> GLPS Avg(0.832)> PSD(0.775),3D LVGLS had an area under the curve(AUC)of 0.845,a cutoff value with-17.68% had sensitivity of 71.1%,specificity of 86.7% and Youden index of 0.578.GLPS Avg had an AUC of 0.832,a cutoff value with-18.37% had sensitivity of 66.7%,specificity of 84.4% and Youden index of 0.511.PSD had an AUC of 0.845,a cutoff value with 42.50 msec had sensitivity of 53.3%,specificity of 93.3% and Youden index of 0.467.9.Reliability:Test-retest reliability analysis showed an intra-class correlation(ICC)of 0.931 for 3D LVGLS and 0.951 for PSD.Inter-observer reliability analysis showed an ICC of 0.852 for 3D LVGLS and 0.876 for PSD.Conclusion1.With the increase of the cumulative doses of doxorubicin,the longitudinal strain and the circumferential strain of left ventricle reduce,and the time to peak strain dispersion of left ventricle increase.The results show that the left ventricular myocardial systolic function and synchronicity of NHL patients treated with doxorubicin-based chemotherapy reduce and have correlations with the cumulative doses of doxorubicin.2.2D STI and 3D STI can assess the mechanical and synchronous changes of left ventricle earlier and more accurately than LVEF in early detection and prediction of cancer therapeutics-related cardiac dysfunction,which are worth promoting.