Zhao Rui, Shu Fang, Zhang Chujie, Song Feiyan, Xu Yuchen, Guo Ye, Xue Kai, Lin Jinyi, Shu Xianhong, Hsi David H, Cheng Leilei
Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China.
Department of Ultrasound, Danyang Hospital of Traditional Chinese Medicine, Jiangsu, China.
JACC CardioOncol. 2020 Mar 17;2(1):13-22. doi: 10.1016/j.jaccao.2020.01.007. eCollection 2020 Mar.
The purpose of this study was to assess the associations between 3-dimensional echocardiography (3DE)-derived changes in right ventricular (RV) volumes and strains with subsequent RV cardiotoxicity in patients treated with anthracyclines.
Although early detection and prediction of left ventricular (LV) dysfunction has been widely studied in patients receiving anthracyclines, little is known about the early changes in RV size and function in this population.
A total of 74 patients with diffuse large B-cell lymphoma who received 6 cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline or before chemotherapy (pre-chemotherapy) (T0); after 2 cycles (T1); after 4 cycles (T2); and at the end of 6 cycles of chemotherapy (T3). Right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), ejection fraction (RVEF), longitudinal free wall strain (RVLFS), and longitudinal septal strain (RVLSS) were quantified by 3DE. RV cardiotoxicity was defined as a relative reduction of >10% in 3D RVEF or a relative reduction of >5% to a value of <45%. Volume status was assessed by inferior vena cava diameter (IVCD) and the estimated right atrial pressure (RAP).
Twenty-seven patients developed cardiotoxicity after 6 cycles of chemotherapy (T3). Compared to baseline, increases in 3D RVEDV (58.5 ± 7.7 ml vs. 64.2 ± 7.0 ml; p < 0.001) and RVESV (27.8 ± 4.2 ml vs. 31.3 ± 4.2 ml; p < 0.001) were observed by the end of the fourth cycle of chemotherapy (T2). 3D RVLFS (-27.3 ± 3.1% vs. -24.2 ± 2.6%; p < 0.001) was also decreased at T2 compared to baseline. Statistically significant declines in 3D RVLSS (-26.1 ± 2.5% vs. -22.9 ± 2.7%; p < 0.001) and RVEF (54.0 ± 2.8% vs. 49.8 ± 2.4%; p < 0.001) were only observed at T3. A relative decrease in RVLFS of >12.4% (sensitivity, 78.6%; specificity, 82.6%; area under the curve (AUC), 0.80; p ＜ 0.001); and a relative increase in RVESV of >13.2% (sensitivity, 71.4%; specificity, 71.7%; AUC, 0.76; p ＜0.001) from baseline to T2 predicted subsequent RV cardiotoxicity at T3. IVCD and RAP did not change significantly over time.
3DE-derived measurements of RV strain and volume were associated with subsequent changes in RVEF. With further study, RVLFS and RVESV could potentially be used to predict subsequent declines in RVEF with anthracyclines.
本研究旨在评估三维超声心动图（3DE）测量的右心室（RV）容积和应变变化与接受蒽环类药物治疗患者随后发生的RV心脏毒性之间的关联。
尽管在接受蒽环类药物治疗的患者中，左心室（LV）功能障碍的早期检测和预测已得到广泛研究，但对于该人群中RV大小和功能的早期变化知之甚少。
共纳入74例接受6周期蒽环类药物治疗的弥漫性大B细胞淋巴瘤患者。在基线或化疗前（T0）、2周期后（T1）、4周期后（T2）以及化疗6周期结束时（T3）进行超声心动图检查。通过3DE对右心室舒张末期容积（RVEDV）、收缩末期容积（RVESV）、射血分数（RVEF）、游离壁纵向应变（RVLFS）和室间隔纵向应变（RVLSS）进行定量分析。RV心脏毒性定义为三维RVEF相对降低>10%或相对降低>5%且降至<45%。通过下腔静脉直径（IVCD）和估计的右心房压力（RAP）评估容量状态。
27例患者在6周期化疗后（T3）发生心脏毒性。与基线相比，化疗第4周期结束时（T2）观察到三维RVEDV增加（58.5±7.7 ml对64.2±7.0 ml；p<0.001）和RVESV增加（27.8±4.2 ml对31.3±4.2 ml；p<0.001）。与基线相比，T2时三维RVLFS也降低（-27.3±3.1%对-24.2±2.6%；p<0.001）。仅在T3时观察到三维RVLSS（-26.1±2.5%对-22.9±2.7%；p<0.001）和RVEF（54.0±2.8%对49.8±2.4%；p<0.001）有统计学意义的下降。从基线到T2，RVLFS相对降低>12.4%（敏感性78.6%；特异性82.6%；曲线下面积（AUC）0.80；p＜0.001）；RVESV相对增加>13.2%（敏感性71.4%；特异性71.7%；AUC 0.76；p＜0.001）可预测T3时随后发生的RV心脏毒性。IVCD和RAP随时间无显著变化。
3DE测量的RV应变和容积与随后的RVEF变化相关。进一步研究后，RVLFS和RVESV可能可用于预测蒽环类药物治疗后RVEF的下降。
