Evaluation Of The Left Ventricular Myocardial Dysfunction Induced By Anthracyclines In Patients With Diffuse Large B-cell Lymphoma By Three-dimensional Speckle Tracking Imaging

Objective Lymphoma is a malignant tumor of the immune system,while the non-Hodgkin lymphoma(NHL)accounts for the vast majority of it,incidence of this disease is on the rise in recent years and it easy occurred early distant spread.Diffuse large B cell lymphoma comprises one of the most common type of non-Hodgkin’s lymphoma,which accounts for about 35% ~ 40%,and after accepting anthracycline-based drugs chemotherapy,the patients can be in long-term disease-free survival.Anthracycline is a kind of curative effect of non-specific broad-spectrum antitumor drug,which is widely used in blood system malignancies and solid tumors of MDT,but its irreversible cardiac toxicity caused by cumulative dose does not allow to ignore.Therefore,actively looking for ways to early detection of cardiac function change has important significance to guide the clinical medication.3D-STI is a new technology in recent years in the development of ultrasonic medical,which can real time tracke and show myocardial motion in three-dimensional space,and is not affected by myocardial movement direction,and also doesn’t depend on the geometry hypothesis.So it could be better able to assess myocardial movements.This study use 3D-STI technology to track the patients with DLBCL treated with CHOP plan chemotherapy,and then explore the value of left ventricular myocardial impairment through the various 3D-STI parameters on the evaluation of the chemotherapy at different cumulative dose of anthracycline,in order to early find the evidence of myocardial damage,then the clinical could timely adjustment of chemotherapy regimens to reduce the case fatality rate.Methods 28 patients confirmed by histopathology of DLBCL were recruited during December 2014 to October 2016 in the department of hemopathology for treatment in the first affiliated hospital of Anhui medical university,who adopt mainly anthracycline-based drugs based CHOP chemotherapy(cyclophosphamide,doxorubicin,vincristine and prednison)for 6 cycles.All patients did not receive radiotherapy involving the chest area,and never had cardiovascular disease through clinical and related auxiliary examination and could be able to get a clear image.Conventional echocardiography and 3D-STI parameters were measured from the twenty-eight patients with DLBCL before chemotherapy,and during 24-48 hours after 2(100 mg/m2),4(200 mg/m2)and 6(300 mg/m2)chemotherapy cycles.ANOVA method compare and analyze the difference of GAS,GLS,GRS and GCS at different chemotherapy cycles.Pearson correlation analysis show the relationship between the cumulative dose of doxorubicin and GAS.Results 1.The non-strain parameters such as LVEF,LVIDd,LVPWd,IVS,ESV and EDV had no statistical significance during the whole chemotherapy process(P>0.05).2.GAS and GLS decreased significantly as the chemotherapy cycles prolonged(P<0.05).During the whole process of chemotherapy,GCS and GRS also reduced as chemotherapy cycles prolonged,but this was not statistically significant(P>0.05).3.GAS and GLS decreased statistically after 4 and 6 chemotherapy cycles compared with before chemotherapy and 2 chemotherapy cycles(P<0.05).GAS and GLS were lower at 6 chemotherapeutic cycles than 4 cycles with statistical significance(P<0.05).4.Before chemotherapy and chemotherapy in patients with 2(100 mg/m2),4(200 mg/m2)and 6(300 mg/m2)chemotherapy cycles,GAS were figured out at(34.86+34.86)%,(34.05 +34.05)%,(28.66+28.66)%,(25.14+2.73)%.Pearson correlation analysis showed GAS was statistically associated with DOX’s cumulativedose(r =-0.834,P <0.01).Conclusion With the chemotherapy prolonging,3D-STI can early detect cardiac toxicity caused by ATC.GAS as the related strain parameters has a high sensitivity to early find the left ventricular function decrease after receiving chemotherapy base on anthracycline drugs,and can accurately track the changes in left ventricular systolic function caused by anthracycline cumulative dose.Therefore,3D-STI has a high clinical value in monitoring the heart subclinical decrease in patients with DLBCL caused by chemotherapy for the CHOP methods.