Evaluation Of Left Atrial Function In Lymphoma Patients With CHOP Regimen By Two-dimensional Speckle Tracking Technique

Objective:To evaluate the changes of left atrial configuration and function in lymphoma patients treated with CHOP regimen in different cycles by two-dimensional speckle tracking imaging（2D-STI）,and to provide decision-making basis for the detection of early myocardial toxicity in lymphoma patients and the adjustment of chemotherapy regimen.Methods:A total of 28 patients with diffuse large B-cell lymphoma who were initially diagnosed by the Department of Hematology in our hospital and needed standard CHOP regimen were selected from September 2017 to August 2018.All patients were required to undergo routine two-dimensional echocardiography（2DE）and 2D-STI before chemotherapy（cumulative dose of 0 mg/m²）.Left ventricular diastolic and systolic function indices were measured by 2DE:LVEF,SV,E/A,E/e,Tei index;left atrial overall function indices:LAV_min,LAV_max,LAV_p.LAEF,LAAEF and LAPEF were calculated.The peak strain rates（SRs,SRe and SRa）of five left atrial walls（lateral wall,atrial septum,anterior wall,inferior wall and posterior wall）at different stages（basal segment,middle segment and roof segment）were collected by 2D-STI technique at different stages（ventricle systolic,early diastolic and late diastolic stages）.Then,after the second cycle of chemotherapy（accumulated dose 100mg/m²）,the fourth cycle（cumulative dose 200mg/m²）,and the sixth cycle（cumulative dose 300mg/m²）,the patient was subjected to echocardiography,and the above various indicators were collected.To compare the changes of various indexes before and during chemotherapy,to evaluate the changes of left ventricular and left atrial function in patients with lymphoma before and during chemotherapy,and to find sensitive indicators that can reflect the toxicity of anthracyclines to myocardial toxicity.Results:（1）There were no significant differences in height,weight and heart rate between the four groups before and during the chemotherapy period（P>0.05）.（2）The indexes of left ventricular diastolic and systolic function in 2DE examination:LVEF,SV,E/A,E/e,,and Tei index were not significantly different between the four groups before and after chemotherapy（P>0.05）.（3）The left atrial function index was examined in 2DE:LAEF,LAAEF,and LAPEF were not significantly different between the four groups before and after chemotherapy（P>0.05）,but the comparison between LAPEF and the two groups was found.The difference of LAPEF between the two groups before chemotherapy and the sixth cycle of chemotherapy was statistically significant（P<0.05）,and there was no significant difference between the other groups（P>0.05）.（4）2D-STI technique examined left atrial segmental functional indicators:SRe,SRa,and SRs showed a downward trend with increasing cumulative dose throughout the chemotherapy cycle.1.In the second cycle of chemotherapy,the SRe of the septum wall（basal segment,middle segment）is significantly lower than that before chemotherapy.SRe of left atrium was significantly lower than that of left atrium before chemotherapy except for inferior wall（roof segment）in the fourth cycle of chemotherapy.The SRe of the left atrium in the sixth cycle of chemotherapy was significantly lower than that before chemotherapy,and the difference was statistically significant（P<0.05）.2.There was no significant difference in SRa between the left atrial segments in the second cycle of chemotherapy and before chemotherapy（P>0.05）.In the fourth cycle of chemotherapy,there were significant differences in SRa between the atrial septum wall（basal segment,middle segment）,inferior（middle segment）and lateral（middle segment）before chemotherapy.There was no significant difference in SRa between the left atrial posterior wall（roof segment）in the sixth cycle of chemotherapy and before chemotherapy（P>0.05）,but there was significant difference in SRa of the remaining segments of left atrium between before and the sixth cycle of chemotherapy.3.There was no significant difference in SRs between the left atrial segments in the second cycle of chemotherapy and before chemotherapy（P>0.05）.SRs of left atrium was significantly lower than that of left atrium before chemotherapy except for inferior（roof segment）and posterior（roof segment）in the fourth cycle of chemotherapy.In the sixth cycle of chemotherapy,there was significant difference between SRs of left atrial segments and those before chemotherapy（P<0.05）.Conclusion:1.2D-STI technology can reflect the changes of left atrial segment function early,and can be applied to the early monitoring of myocardial toxicity of anthracyclines in patients with DLBCL.2.The indexes of SRe,SRa and SRs in 2D-STI decreased significantly in the early stage of chemotherapy,and the time to decrease SRe was the earliest.Therefore,SRe,SRa and SRs could be used as early indicators for monitoring the left atrial myocardial toxicity of anthracyclines.