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Subclinical Anthracycline-Induced Cardiotoxicity in the Long - Term Follow-Up of Lymphoma Survivors: A Multi-Layer Speckle Tracking Analysis / Cardiotoxicidade Subclínica Induzida por Antraciclina no Seguimento a Longo Prazo de Sobreviventes de Linfoma: Uma Análise Speckle Tracking Multi-Layer
Kang, Yu; Xiao, Fei; Chen, Haiyan; Wang, Wei; Shen, Lijing; Zhao, Hang; Shen, Xuedong; Chen, Fangyuan; He, Ben.
  • Kang, Yu; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Xiao, Fei; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Chen, Haiyan; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Wang, Wei; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Shen, Lijing; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Zhao, Hang; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Shen, Xuedong; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • Chen, Fangyuan; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
  • He, Ben; Shanghai Jiaotong University. School of Medicine. Renji Hospital. Shanghai. CN
Arq. bras. cardiol ; 110(3): 219-228, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-888028
ABSTRACT
Abstract

Background:

Anthracycline generates progressive left ventricular dysfunction associated with a poor prognosis.

Objectives:

The purpose of this study was to evaluate whether layer-specific strain analysis could assess the subclinical left ventricular dysfunction after exposure to anthracycline.

Methods:

Forty-two anthracycline-treated survivors of large B-cell non-Hodgkin lymphoma, aged 55.83 ± 17.92 years (chemotherapy group) and 27 healthy volunteers, aged 51.39 ± 13.40 years (control group) were enrolled. The cumulative dose of epirubicin in chemotherapy group was 319.67 ± 71.71mg/m2. The time from last dose of epirubicin to the echocardiographic examination was 52.92 ± 22.32 months. Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), subendocardial, mid and subepicardial layer of longitudinal (LS-ENDO, LS-MID, LS-EPI) and circumferential strain (CS-ENDO, CS-MID, CS-EPI) values were analyzed. Transmural strain gradient was calculated as differences in peak systolic strain between the subendocardial and subepicardial layers. A value of p < 0.05 was considered significant.

Results:

Conventional parameters of systolic and diastolic function showed no significant difference between two groups. Compared with controls, patients had significantly lower GCS and GLS. Multi-layer speckle tracking analysis showed significant reduction of circumferential strain of subendocardial layer, transmural CS gradient and longitudinal strain of all three layers. In contrast, the two groups did not differ in transmural longitudinal strain gradient and radial strains.

Conclusions:

It proved the preferential impairment of subendocardial deformation in long-term survivors after exposure to anthracycline. Multi-layer speckle tracking echocardiography might facilitate the longitudinal follow-up of this at-risk patient cohort.
RESUMO
Resumo Fundamentos A antraciclina gera uma disfunção ventricular esquerda progressiva associada a um prognóstico ruim.

Objetivos:

O propósito deste estudo foi avaliar se a análise layer específico de strain poderia avaliar disfunção ventricular esquerda subclínica após exposição a antraciclina.

Métodos:

Foram inscritos quarenta e dois sobreviventes tratados com antraciclina por linfoma não Hodgkin de células B grandes, de 55,83 ± 17,92 anos (grupo de quimioterapia) e 27 voluntários saudáveis, de 51,39 ± 13,40 anos (grupo controle). A dose cumulativa de epirrubicina no grupo de quimioterapia foi de 319,67 ± 71,71 mg/m2. O tempo desde a última dose de epirrubicina até o exame ecocardiográfico foi de 52,92 ± 22,32 meses. Analisaram-se o strain longitudinal global (GLS), o circunferencial (GCS) e o strain radial (GRS), os valores das camadas subendocárdica, média e subepicárdica so strain longitudinal (LS-ENDO, LS-MID, LS-EPI) e do strain circunferencial (CS-ENDO, CS-MID, CS-EPI). O gradiente de strain transmural foi calculado como a diferença no strain sistólico pico entre as camadas subendocárdicas e subepicárdicas. Um valor de p < 0,05 foi considerado significativo.

Resultados:

Os parâmetros convencionais da função sistólica e diastólica não mostraram diferenças significativas entre dois grupos. Comparados aos controles, os pacientes apresentaram GCS e GLS significativamente menores. A análise de speckle tracking multi-layer mostrou uma redução significativa no strain circunferencial da camada subendocárdica, o gradiente transmural CS e o strain longitudinal das três camadas. Em contraste, os dois grupos não diferiram no gradiente de strain longitudinal transmural e de strain radiais.

Conclusões:

Provou-se a deterioração preferencial do strain subendocárdico em sobreviventes de longa duração após exposição à antraciclina. O ecocardiograma de speckle tracking multi-layer pode facilitar o acompanhamento longitudinal dessa coorte de pacientes em risco. (Arq Bras Cardiol. 2018; 110(3)219-228)
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Echocardiography / Lymphoma, B-Cell / Ventricular Dysfunction, Left / Anthracyclines / Antibiotics, Antineoplastic Type of study: Etiology study / Evaluation studies / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male Language: English Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2018 Type: Article Affiliation country: China Institution/Affiliation country: Shanghai Jiaotong University/CN

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Full text: Available Index: LILACS (Americas) Main subject: Echocardiography / Lymphoma, B-Cell / Ventricular Dysfunction, Left / Anthracyclines / Antibiotics, Antineoplastic Type of study: Etiology study / Evaluation studies / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male Language: English Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2018 Type: Article Affiliation country: China Institution/Affiliation country: Shanghai Jiaotong University/CN