Rihackova Eva, Rihacek Michal, Boucek Lubos, Vyskocilova Maria, Elbl Lubomir
Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Sci Rep. 2025 Mar 18;15(1):9372. doi: 10.1038/s41598-025-93933-2.
Malignant lymphoma survivors are at increased risk for anthracycline and/or radiotherapy-induced chronic cardiotoxicity. Proper long-term follow-up is essential for malignant lymphoma survivors after-care. This study aimed to assess TTE parameters of potential subclinical cardiotoxicity and to examine their utility in diagnosing chronic cardiotoxicity. Improvement of the diagnostic process may precede the manifestation of cardiac adverse events. Main objective of the study was to improve the identification of cancer survivors in increased risk of treatment cardiotoxicity. To achieve this goal, utility of various echocardiography parameters was examined.In this retrospective study we analysed TTE of 167 subjects with speckle tracking according to the European Society of Echocardiography guidelines during the follow-up period. 88 of them were long-term lymphoma survivors diagnosed with malignant lymphoma between the years 1994-2015. Minimum follow up period was 5 years with the median of 10 years after anti-cancer treatment cessation. TTE were performed between the years 2017-2022 at cardio-oncology outpatient office during regular follow-up period. A total of 79 volunteers with no history of chronic heart failure (CHF) or decline in LVEF, 51 (64.6%) of whom were males, with the median age of 46 (16-58) years were included in the analysis as control group. Control subjects had various indications for TTE (e.g. preoperative examination, benign palpitations, or with well controlled arterial hypertension taking two antihypertensives at most). Ischemic heart disease was ruled out by stress test. None of the control subjects had history of stroke or chronic lower limb ischemia. All control subjects were considered clinically stable with no sign of cardiac impairment caused by primary disease. Both cancer survivors and control group were divided into subgroups based on LVEF: lower normal LVEF (53-61%), and higher normal LVEF (> 61%). Survivors with lower normal LVEF (53-61%) had a statistically significant decline in GLS compared to those with higher normal LVEF (> 61%). This phenomenon was not observed in control group indicating a possible additional diagnostic value of this parameter. Inclusion of GLS assessment in follow-up TTE examination of subjects with lower normal LVEF may improve the sensitivity of detection of chronic cardiotoxicity. Patients with declined GLS and lower normal LVEF are candidates for intensified follow-up to precede manifestation of cardiac adverse events.
恶性淋巴瘤幸存者发生蒽环类药物和/或放疗所致慢性心脏毒性的风险增加。恰当的长期随访对于恶性淋巴瘤幸存者的后续护理至关重要。本研究旨在评估潜在亚临床心脏毒性的经胸超声心动图（TTE）参数，并检验其在诊断慢性心脏毒性中的效用。诊断过程的改进可能先于心脏不良事件的出现。本研究的主要目的是改善对有治疗性心脏毒性增加风险的癌症幸存者的识别。为实现这一目标，对各种超声心动图参数的效用进行了检验。在这项回顾性研究中，我们根据欧洲超声心动图学会指南，在随访期间对167名采用斑点追踪技术的受试者进行了TTE分析。其中88人是1994年至2015年间被诊断为恶性淋巴瘤的长期淋巴瘤幸存者。抗癌治疗停止后的最短随访期为5年，中位随访期为10年。TTE于2017年至2022年期间在心脏肿瘤门诊定期随访时进行。共有79名无慢性心力衰竭（CHF）病史或左心室射血分数（LVEF）下降的志愿者被纳入分析作为对照组，其中51人（64.6%）为男性，中位年龄为46岁（16 - 58岁）。对照组受试者进行TTE有各种指征（如术前检查、良性心悸或最多服用两种降压药且血压控制良好的动脉高血压患者）。通过负荷试验排除了缺血性心脏病。对照组受试者均无中风或慢性下肢缺血病史。所有对照组受试者在临床上均被认为稳定，无原发性疾病所致心脏损害的迹象。癌症幸存者和对照组均根据LVEF分为亚组：较低正常LVEF（53 - 61%）和较高正常LVEF（> 61%）。与较高正常LVEF（> 61%）的幸存者相比，较低正常LVEF（53 - 61%）的幸存者的整体纵向应变（GLS）有统计学意义的下降。在对照组中未观察到这种现象，这表明该参数可能具有额外的诊断价值。在较低正常LVEF受试者的随访TTE检查中纳入GLS评估可能会提高慢性心脏毒性检测的敏感性。GLS下降且LVEF较低正常的患者是加强随访以预防心脏不良事件出现的候选对象。
