Evaluation of subclinical dysfunction of left ventricle induced by anthracyclines in patients with diffuse large B-cell lymphoma by real-time three dimensional echocardiography

Objective To explore the value of real-time three-dimensional echocardiography (RT3DE) in the assessment of subclinical dysfunction of left ventricle (LV) induced by anthracyclines in patients with diffuse large B-cell lymphoma (DLBCL). Furthermore, to explore the sensitive parameters of RT3DE in the assessment of subclinical dysfunction of LV. Methods RT3DE images were acquired from twenty-six patients with DLBCL before chemstherapy, after 2(100 mg/m2), 4(200 mg/m2) and 6(300 mg/m2) chemotherapy cycles for evaluation and analysis to obtain LV end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF). Global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular twist (LVtw) and left ventricular torsion (LVtor) were also calculated. Results Changes in EDV[(71.4±14.8)mL, (76.3±15.6)mL, (81.7±19.5)mL, (79.7±16.2)mL]、ESV[(22.9±5.1)mL, (25.1±5.4)mL, (27.1±8.1)mL, (26.6±6.7)mL], SV[(48.6±10.4)mL, (51.2±11.0)mL, (54.6±12.8)mL, (53.1±10.7)mL], EF[(67.9±3.1)%, (66.9±3.1)%, ( 67.0±4.1)%, (66.7±3.6)%], GLS[(-26.9±4.8)%, (-27.1±4.4)%, (-25.5±7.5)%, (-26.7±7.1)%], GCS[(-34.7±2.5)%, (-33.7±3.4)%, (-34.1±3.8)%, (-33.7±3.3)%] showed no significant degradation compared with the parameters at baseline as well as, after 2, 4 and 6 chemotherapy cycles (F=1.095, 2.297, 1.388, 0.628, 0.344, 0.585, respectively, all P>0.05), while the variations on LVtw[(19.9±6.8)°, (13.1±10.0)°, (13.5±8.1)°, (11.1±5.8)°], LVtor[(2.9±1.2)°/cm, (1.8±1.4)°/cm, (1.8±1.1)°/cm, (1.5±0.8)°/cm] decreased statistically compared with the data at baseline, and after 2, 4 and 6 chemotherapy cycles (F=6.007, 7.013, respectively, P<0.05, respectively). Changes on LVtw, LVtor showed statistically reduction after 2, 4 and 6 chemotherapy cycles compared with the parameter at baseline (LVtw: P=0.025, 0.016, 0.001, respectively; LVtor: P=0.008, 0.007, 0.000, respectively). Conclusion LVtw and LVtor derived from RT3DE may be used as sensitive parameters to detect subclinical left ventricular dysfunction in patients with DLBCL underwent anthracycline therapy. Key words: Anthracyclines; Lymphoma; Ventricular dysfunction, left; Echocardiography, three-dimensional