Subclinical Anthracycline-Induced Cardiotoxicity in the Long-Term Follow-Up of Lymphoma Survivors: A Multi-Layer Speckle Tracking Analysis

Abstract

BackgroundAnthracycline generates progressive left ventricular dysfunction associated with a poor prognosis.ObjectivesThe purpose of this study was to evaluate whether layer-specific strain analysis could assess the subclinical left ventricular dysfunction after exposure to anthracycline.MethodsForty-two anthracycline-treated survivors of large B-cell non-Hodgkin lymphoma, aged 55.83 ± 17.92 years (chemotherapy group) and 27 healthy volunteers, aged 51.39 ± 13.40 years (control group) were enrolled. The cumulative dose of epirubicin in chemotherapy group was 319.67 ± 71.71mg/m2. The time from last dose of epirubicin to the echocardiographic examination was 52.92 ± 22.32 months. Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), subendocardial, mid and subepicardial layer of longitudinal (LS-ENDO, LS-MID, LS-EPI) and circumferential strain (CS-ENDO, CS-MID, CS-EPI) values were analyzed. Transmural strain gradient was calculated as differences in peak systolic strain between the subendocardial and subepicardial layers. A value of p < 0.05 was considered significant.ResultsConventional parameters of systolic and diastolic function showed no significant difference between two groups. Compared with controls, patients had significantly lower GCS and GLS. Multi-layer speckle tracking analysis showed significant reduction of circumferential strain of subendocardial layer, transmural CS gradient and longitudinal strain of all three layers. In contrast, the two groups did not differ in transmural longitudinal strain gradient and radial strains.ConclusionsIt proved the preferential impairment of subendocardial deformation in long-term survivors after exposure to anthracycline. Multi-layer speckle tracking echocardiography might facilitate the longitudinal follow-up of this at-risk patient cohort.

Early detection of subclinical left ventricular dysfunction after breast cancer radiation therapy using speckle-tracking echocardiography: association between cardiac exposure and longitudinal strain reduction (BACCARAT study)

“…Other studies averaged the three layers of GLS [11, 26], but we chose to focus here on the middle layer considering that this GLS would be a good indicator of the association with radiation exposure in the LV wall in addition to the fact that it has been shown in several studies to be robust and reproducible [24]. Further analysis detailing the three layers are in progress and may allow refining our results as previously observed for chemotherapy [35].…”

The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients—Is There More Than Just Left Ventricle Global Longitudinal Strain?

“…However, the clinical value of layer-specific assessment is questionable, mainly due to low visibility of the wall for tracking [ 13 ]. Although contractile force is greater in the endocardial layer than in the epicardial layer [ 35 ], it is also more susceptible to injury due to its higher energy requirements. Previous studies have demonstrated that layer specific strain is more accurate for discriminating the various intensities of transmural scarring compared to CMR [ 36 ].…”

What is the Role of Two-Dimensional Speckle Tracking Echocardiography in the Diagnosis and Management of Anthracycline-Induced Cardiotoxicity?

“…Kang et al 9 have not observed a direct relationship between anthracycline doses and strain values, suggesting that the myocardial damage, reflected on impaired myocardial deformation, can occur even at doses considered non-cardiotoxic (lower than 240 mg/m 2 ), provided that the population studied used doses ranging from 150.94 mg/m 2 to 440.00 mg/m 2 .…”

“…Even without definite responses, the study by Kang et al 9 contributes to reinforce the importance of combining the clinical practice with a sensitive non-invasive method to aid the management of oncologic patients during and after chemotherapy. 10 , 11 …”

“…In this issue of the Arquivos Brasileiros de Cardiologia , Kang et al. 9 make a relevant contribution to the diagnosis of anthracycline-induced cardiotoxicity. In a cohort of survivors of non-Hodgkin's diffuse large B cell lymphoma treated with anthracyclines, those authors have shown that, as compared to healthy controls, those patients have lower values of circumferential and longitudinal strains on echocardiography in a population with normal ejection fraction.…”