Two‐dimensional speckle tracking echocardiography combined with high‐sensitive cardiac troponin T in early detection and prediction of cardiotoxicity during epirubicine‐based chemotherapy

Abstract

Aims To investigate whether alterations of myocardial strain and high‐sensitive cardiac troponin T (cTnT) could predict future cardiac dysfunction in patients after epirubicin exposure. Methods Seventy‐five patients with non‐Hodgkin lymphoma treated with epirubicin were studied. Blood collection and echocardiography were performed at baseline, 1 day after the third cycle, and 1 day after completion of chemotherapy. Patients were studied using echocardiography during follow‐up. Global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were calculated using speckle tracking echocardiography. Left ventricular ejection fraction was analysed by real‐time 3D echocardiography. Cardiotoxicity was defined as a reduction of the LVEF of ≥5% to <55% with symptoms of heart failure or an asymptomatic reduction of the LVEF of ≥10% to <55%. Results Fourteen patients (18.67%) developed cardiotoxicity after treatment. GLS (−18.48 ± 1.72% vs. −15.96 ± 1.6%), GCS (−20.93 ± 2.86% vs. −19.20 ± 3.21%), and GRS (39.23 ± 6.44% vs. 34.98 ± 6.2%) were markedly reduced and cTnT was elevated from 0.0010 ± 0.0020 to 0.0073 ± 0.0038 ng/mL (P all < 0.01) at the completion of chemotherapy compared with baseline values. A >15.9% decrease in GLS [sensitivity, 86%; specificity, 75%; area under the curve (AUC) = 0.815; P = 0.001] and a >0.004 ng/mL elevation in cTnT (sensitivity, 79%; specificity, 64%; AUC = 0.757; P = 0.005) from baseline to the third cycle of chemotherapy predicted later cardiotoxicity. The decrease in GLS remained the only independent predictor of cardiotoxicity (P = 0.000). Conclusions GLS combined with cTnT may provide a reliable and non‐invasive method to predict cardiac dysfunction in patients receiving anthracycline‐based chemotherapy.

The early variation of left ventricular twisting function in patients with lymphoma received anthracycline therapy assessed by three-dimensional speckle tracking echocardiography

“…A large study by Khan et al [48], involving 1204 patients, showed 10.2% (n = 123) patients occurred cardiotoxicity which was defined as a reduction in LVEF ≥ 10% absolute points from baseline and LVEF < 55%. Meanwhile, another study with 75 patients reported that 18.67% patients developed an asymptomatic reduction of the LVEF of ≥ 10% after epirubicin therapy [49]. The present results appeared to be discordant with these two studies, however, their patients had received anthracycline > 300 mg/m 2 which were higher than our cumulative dose.…”

Subclinical Myocardial Impairment Occurred in Septal and Anterior LV Wall Segments After Anthracycline-Embedded Chemotherapy and did not Worsen During Adjuvant Trastuzumab Treatment in Breast Cancer Patients

“…Moreover, it has a lower inter-observer variability [39]. In a recent study of non-Hodgkin lymphoma patients, measurements if global longitudinal strain combined with troponin T provided a reliable method to predict cardiac dysfunction in patients receiving anthracycline-based chemotherapy [40]. In our systematically controlled cohort trial, we could also show an impairment of the LV-EF predominantly during chemotherapy.…”

Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants.

“…Whether longitudinal systolic performance precedes the onset of DD (as suggested by smaller studies [41,14]), or whether it is an event that succeeds it -a sign of progression towards systolic heart failure? And what is the predictive value of longitudinal performance impairment for the progression towards heart failure?…”