Analysis Of Risk Factors For Anthracycline Cardiotoxicity And The Value Of Three-dimensional Speckle Tracking Ultrasound In Monitoring Chemotherapy-related Cardiotoxicity

Objective:To explore the risk factors for cardiac toxicity in patients with non-Hodgkin's lymphoma treated with anthracyclines,and to evaluate the value of three-dimensional speckle tracking technology in monitoring chemotherapy-related cardiac toxicity.Methods:1 Analysis of risk factors for anthracycline cardiotoxicity:A total of 364 adult patients with pathologically diagnosed NHL from January 1,2013 to December 30,2018 in the Department of Lymphoma Oncology at Shanxi Bethune Hospital were collected.They all received R-CHOP-like protocol.Clinical data such as age,history of hypertension,type 2 diabetes,body mass index(BMI),hyperlipidemia,B symptoms,and Ann Arbor staging were collected.SPSS23.0 software was used to analyze the above data,?~2 test was used to compare the classification data,and logistic regression analysis was used for multivariate analysis.2 The value of three-dimensional speckle tracking ultrasound in monitoring chemotherapy-related cardiac toxicity:Thirty-eight patients with pathological diagnosis of NHL in the Department of Lymphoma Oncology in Bethune Hospital affiliated to Shanxi Medical University from January 2018 to October 2019 were collected.All patients underwent conventional echocardiography and three-dimensional speckle tracking echocardiography after baseline(T0)and second(T2),fourth(T4),sixth(T6),and eighth(T8)chemotherapy cycles.Collect routine ultrasound parameters:left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),early peak diastolic flow rate(E)and late peak diastolic flow rate(A).Ratio(E/A).Strain parameters were collected:global longitudinal strain of the left ventricle(GLS),global circumferential strain of the left ventricle(GCS),global radial strain of the left ventricle(GRS),and global area of the left ventricle(GAS).Data were expressed as((?)±s).Comparisons between groups were performed by one-way analysis of variance.Pearson correlation analysis was used to test the correlation between statistically significant indicators and the cumulative dose of doxorubicin.Results:1 Analysis of risk factors for anthracycline cardiotoxicity:1.1 Incidence of cardiotoxicity:Among the patients enrolled,29(8%)met cardiotoxic events that met the diagnostic criteria.1.2 Univariate analysis of influencing factors of cardiotoxic events:age?60 years,history of previous hypertension,cumulative doxorubicin dose?200mg/m~2,and the correlation with cardiotoxic events was statistically significant(P<0.05).1.3 Multivariate analysis of influencing factors of cardiotoxicity events:(1)age?60 years old,previous history of hypertension and cumulative dose of adriamycin?200mg/m~2 are independent risk factors for cardiotoxicity events(P<0.05);(2)age?60Compared with patients less than 60 years of age,the risk of cardiotoxic events increased by 3.431 times;(3)the risk of cardiotoxic events increased by 2.748 times in patients with a history of hypertension and a history of no hypertension;(4)cumulative dose of adriamycin at 200 mg/m~2,the risk of cardiotoxic events increased by 11.612 times compared with patients with a cumulative dose of doxorubicin<200 mg/m~2.2 The value of three-dimensional speckle tracking ultrasound in monitoring chemotherapy-related cardiac toxicity:2.1 Comparison of conventional echocardiographic parameters:There was no statistically significant difference in the routine ultrasound parameters LEDV,LESV,LVEF and E/A ratio between T0 and T2,T4,T6 and T8 cycles(P>0.05).2.2 3D speckle tracking technology comparison between inspection parameters:2.2.1 Univariate analysis results:GLS decreased after T4 cycles of chemotherapy compared with T0 cycles,the difference was statistically significant(P<0.05);GAS decreased after T6 cycles of chemotherapy compared with T0 cycles,and the differences were statistically significant(P<0.05)).2.2.2 Analysis of cumulative correlation between GLS and GAS and doxorubicin dose:As the cumulative dose of doxorubicin increased,GLS and GAS showed a gradual decrease.Conclusion:1 NHL patients treated with anthracyclines have a high incidence of cardiotoxic events,and are aged?60 years,previous history of hypertension,and cumulative dose of adriamycin?200 mg/m~2,which are risk factors for cardiotoxic events.2 For NHL patients treated with anthracyclines,even if the LVEF is normal,there is still a risk of left ventricular dysfunction,which is manifested by a decrease in GLS and GAS values,and as the cumulative dose of adriamycin increases,GLS and GAS are gradually decreasing.Three-dimensional speckle tracking technology can effectively evaluate the possible subclinical cardiac function changes in patients after anthracycline treatment.