| Objective : Anthracycline is an important component of first-line chemotherapy for nonHodgkin lymphoma patients.However,it has significant dose-cumulative myocardial toxicity and can cause irreversible myocardial damage,which often limits clinical applications.Early detection of chemotherapy-induced myocardial toxicity will help to take early cardiac protective measures to improve the quality of life of patients in the later period.As a new ultrasonic index,myocardial work(MW)reflects the metabolism and oxygen consumption of left ventricle.The value of myocardial work in detecting myocardial damage during chemotherapy in non-Hodgkin lymphoma(NHL)patients is unclear.The purpose of this study was to evaluate the changes of two-dimensional strain and left ventricular myocardial work parameters in non-Hodgkin lymphoma patients treated with Anthracycline chemotherapy using two-dimensional speckle tracking imaging combined with noninvasive myocardial work(MW),and to explore the value of myocardial work parameters in the evaluation of early cardiac injury induced by chemotherapy,in the hope of finding a new parameter to help early detection of myocardial injury,to improve long-term survival in non-Hodgkin lymphoma patients.Methods: From September 2020 to September 2022,38 patients with diffuse large b-cell lymphoma(DLBCL)were selected from the Department of Hematology,the First Affiliated Hospital of Dalian Medical University,the standard chemotherapy regimen based on doxorubicin was used,with a cycle of 21 days and 6-8 cycles of chemotherapy.Brachial artery blood pressure of upper extremity was measured and recorded at rest in all patients before chemotherapy,before the fifth cycle of chemotherapy,and after the end of chemotherapy,and 4-6 months after chemotherapy.Then,according to the routine echocardiography and two-dimensional speckle tracking echocardiography,the corresponding ultrasound sections were collected and the images were stored.The stored images were imported into the clinical workstation ECHOPAC for offline analysis,the global longitudinal strain(GLS)of 17 segments of left ventricle was analyzed by myocardial automatic function imaging(AFI),then thesystolic and diastolic blood pressure measured by the cuff was input,and the myocardial work parameters were obtained by using the left ventricular pressure-strain loop(LV-PSL)technique,including the global work index(GWI),the global constructive work(GCW),the global wasted work(GWW),the global work efficiency(GWE).Blood samples were collected at the same time point to detect the concentration of biomarkers in blood,and finally the parameters were analyzed and compared between groups,further analysis of each index to assess the value of patients with cancer treatment-related cardiac dysfunction(CTRCD).Result:1.Baseline clinical data comparison: of the 38 patients who met the inclusion criteria and had multiple cycles of follow-up,a total of 4 patients developed CTRCD;One patient developed CTRCD before the 5th cycle of chemotherapy,and 3 patients developed CTRCD after chemotherapy.There were no significant differences in age,sex,cardiac risk factors(hypertension,diabetes,smoking)and cardiovascular treatment(ARB and β-blocker)between CTRCD Group and non-CTRCD group before chemotherapy(p>0.05)2.Comparison of conventional ultrasound parameters,GLS and MW parameters: compared with pre-chemotherapy,GLS was significantly decreased in patients with diffuse large b-cell lymphoma before the 5th cycle of chemotherapy(P<0.05),and after chemotherapy(up to 8 cycles),left ventricular ejection fraction(LVEF)was significantly decreased(P < 0.05),GWW was significantly increased,GWE was significantly decreased(both P<0.05),GCW and GWI were significantly decreased 4-6 months after chemotherapy(P<0.05),there was no significant difference in other echocardiography parameters before and after chemotherapy(all P>0.05).3.GLS is an independent predictor of left ventricular dysfunction after Anthracycline chemotherapy,with an absolute value of GLS ≤12% before Cycle 5,which can be used to identify chemotherapy-induced left ventricular dysfunction early.4.The MW parameters can quantify changes in cardiac function during chemotherapy and follow-up.5.Blood biomarkers(hs-c Tn,BNP,NT-pro BNP)increased with the chemotherapy cycle,but there was no statistical significance(P>0.05).Conclusion:1.For non-Hodgkin lymphoma patients with normal blood pressure and good control of blood pressure,GLS is superior to myocardial work parameters in predicting CTRCD.2.The myocardial work parameters obtained from LV-PSL can be used to evaluate the changes of left ventricular function during chemotherapy for non-Hodgkin lymphoma,and GWW and GWE can detect the changes of left ventricular function relatively early,it can provide an important basis for clinical monitoring of the impairment of cardiac function. |
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