Myocardial work—A new tool for early detection of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone chemotherapy induced‐cardiotoxicity in hematological patients

Abstract

Background Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP) chemotherapy in non‐Hodgkin's lymphoma (NHL) has risk of cardiotoxicity. Purpose To determine the role of myocardial work and biomarkers in subclinical diagnosis and prediction of cardiotoxicity. Methods The 130 NHL patients (52 ± 9 years, 62% men) scheduled for RCHOP, with LVEF>50%, were evaluated at baseline, after third cycle and chemotherapy completion for 3D LVEF, 2D myocardial deformation (longitudinal, radial, circumferential strain ‐ LS, RS, CS) and myocardial work (global constructive work, waste work, work index and work efficiency ‐ GCW, GWW, GWI, GWE). NT‐pro‐BNP and troponin I were determined. Results After chemotherapy ended, 37 patients (28%) (group I) developed asymptomatic cardiotoxicity (8 mild form, 25 moderate form, 4 severe form); 93 patients (group II) did not. After third cycle, all patients had decreased LS, CS, RS, GCW, GWI, GWE and increased GWW, persistent after chemotherapy completion, with significant changes in group I. After third cycle, GWE and GCW were the best independent predictors for LVEF reduction; GWE decrease with>5% after third cycle predicted cardiotoxicity after chemotherapy completed (91% sensitivity, 94% specificity). Conclusions In NHL, myocardial work can diagnose subclinical cardiotoxicity and predict LVEF decline. These parameters should be used for sensitive evaluation of myocardial function during chemotherapy.

Anthracycline‐induced cardiotoxicity on regional myocardial work and left ventricular mechanical dispersion in adolescents and young adults in post‐lymphoma remission

“…19,[40][41][42] Assessments of MW were already done in preclinical and adult cohorts patients. 21,22,43 For example, MW has been assessed in ischemic cardiac disease, allowing the detection of subclinical coronary artery disease without any regional wall motion abnormalities, and has more sensitivity for myocardial oxygen consumption. 26 In pediatric population, Zhan et al recently demonstrated that global MWI enhanced hypertensive heart disease evaluation and cardiac dysfunction during and after chemotherapy follow-up.…”

Myocardial work and permissive cardiotoxicity – A proactive approach in cardio‐oncology

“…In these patients, MW seems to diagnose subclinical cardiotoxicity and predict left ventricular (LV) systolic decline. An early reduction of global work efficiency with more than 5%, after third cycle of chemotherapy, seems to predict the occurrence of cardiotoxicity, after the ending of cures 2 . The manuscript is very important, first, because the authors used, for the first time MW in the RCHOP chemotherapy‐induced myocardial dysfunction detection.…”

“…In the article entitled: “Myocardial work – A new tool for early detection of RCHOP chemotherapy induced‐cardiotoxicity in hematological patients” by Mihalcea et al, 2 the authors aimed “to determine the role of myocardial work (MW) and biomarkers in subclinical diagnosis and prediction of cardiotoxicity” in patients non‐Hodgkin's lymphoma. In these patients, MW seems to diagnose subclinical cardiotoxicity and predict left ventricular (LV) systolic decline.…”

“…This new concept is a proactive concept to continuation of lifesaving cancer therapies in order to achieve the best oncologic outcome while mitigating associated and potentially off-target cardiotoxicities. 1 In the article entitled: "Myocardial work -A new tool for early detection of RCHOP chemotherapy induced-cardiotoxicity in hematological patients" by Mihalcea et al, 2 the authors aimed "to determine the role of myocardial work (MW) and biomarkers in subclinical diagnosis and prediction of cardiotoxicity" in patients non-Hodgkin's lymphoma. In these patients, MW seems to diagnose subclinical cardiotoxicity and predict left ventricular (LV) systolic decline.…”

“…An early reduction of global work efficiency with more than 5%, after third cycle of chemotherapy, seems to predict the occurrence of cardiotoxicity, after the ending of cures. 2 The manuscript is very important, first, because the authors used, for the first time MW in the RCHOP chemotherapy-induced myocardial dysfunction detection. Second, this non-invasive echocardiographic parameter, namely global work efficiency, might be the first tool of the new concept in cardio-oncology, permissive cardiotoxicity.…”