Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Cardiology Department, University and Emergency Hospital, Bucharest, Romania.
J Clin Ultrasound. 2023 Mar;51(3):377-384. doi: 10.1002/jcu.23388. Epub 2022 Nov 4.
Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP) chemotherapy in non-Hodgkin's lymphoma (NHL) has risk of cardiotoxicity.
To determine the role of myocardial work and biomarkers in subclinical diagnosis and prediction of cardiotoxicity.
The 130 NHL patients (52 ± 9 years, 62% men) scheduled for RCHOP, with LVEF>50%, were evaluated at baseline, after third cycle and chemotherapy completion for 3D LVEF, 2D myocardial deformation (longitudinal, radial, circumferential strain - LS, RS, CS) and myocardial work (global constructive work, waste work, work index and work efficiency - GCW, GWW, GWI, GWE). NT-pro-BNP and troponin I were determined.
After chemotherapy ended, 37 patients (28%) (group I) developed asymptomatic cardiotoxicity (8 mild form, 25 moderate form, 4 severe form); 93 patients (group II) did not. After third cycle, all patients had decreased LS, CS, RS, GCW, GWI, GWE and increased GWW, persistent after chemotherapy completion, with significant changes in group I. After third cycle, GWE and GCW were the best independent predictors for LVEF reduction; GWE decrease with>5% after third cycle predicted cardiotoxicity after chemotherapy completed (91% sensitivity, 94% specificity).
In NHL, myocardial work can diagnose subclinical cardiotoxicity and predict LVEF decline. These parameters should be used for sensitive evaluation of myocardial function during chemotherapy.
利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松（RCHOP）化疗治疗非霍奇金淋巴瘤（NHL）有心脏毒性的风险。
确定心肌做功和生物标志物在亚临床诊断和预测心脏毒性中的作用。
130 名 NHL 患者（52±9 岁，62%为男性）计划接受 RCHOP 治疗，LVEF>50%，在基线、第三个周期后和化疗结束时进行 3D LVEF、2D 心肌变形（纵向、径向、环向应变- LS、RS、CS）和心肌做功（整体建设性工作、浪费工作、工作指数和工作效率-GCW、GWW、GWI、GWE）评估。测定 NT-pro-BNP 和肌钙蛋白 I。
化疗结束后，37 名（28%）患者（I 组）出现无症状性心脏毒性（8 例轻度、25 例中度、4 例重度）；93 名（II 组）患者未出现。第三个周期后，所有患者 LS、CS、RS、GCW、GWI、GWE 降低，GWW 升高，化疗结束后持续存在，I 组变化显著。第三个周期后，GWE 和 GCW 是 LVEF 降低的最佳独立预测因子；第三个周期后 GWE 下降>5%预测化疗后心脏毒性（91%的敏感性，94%的特异性）。
在 NHL 中，心肌做功可诊断亚临床心脏毒性并预测 LVEF 下降。这些参数应在化疗期间用于敏感评估心肌功能。
