| Citation: |
CHEN Jia-hui, ZHANG Chu-jie, SHEN Yi-hui, et al. Late detection of left ventricular mechanical dyssynchrony and impaired morphology after high dose of anthracycline chemotherapy using real-time three-dimensional echocardiography: a 5-year retrospective follow-up study[J]. Chin J Clin Med, 2021, 28(2): 145-151. DOI: 10.12025/j.issn.1008-6358.2021.20210323
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To identify the left ventricular (LV) geometric deformation and mechanical dyssynchrony using real-time three-dimensional echocardiography (RT-3DE) and three-dimensional speckle tracking imaging (3D-STI) in long-term diffuse large B-cell non-Hodgkin lymphoma (DLBCL) survivors after high and low dosage anthracycline chemotherapy.
A total of 20 long-term survival DLBCL patients and 36 age-matched healthy controls were selected. In the case group, twenty patients (55% male) with DLBCL were followed for (4.8±1.0) years after the last cycle of anthracycline-based treatment. Survivors were divided into high dose (n=15, >360 mg/m2) and low dose (n=5, ≤ 360 mg/m2) subgroups according to their exposure to the cumulative dosage of anthracycline. All participants in the case and control groups underwent two-(2D-) and three-dimensional (3D-) echocardiographic assessments. 3D-STI was performed to estimate LV global longitudinal strain (GLS), global circumferential strain (GCS), torsion, and twist. LV systolic dyssynchrony index (SDI) was calculated as the percentage of the dispersion of time-to-minimum regional volume using a 16-segment model divided by the RR interval.
Compared with controls, significant decreases in LVEF ([60.0±7.9]% vs[63.2±2.3]%, P=0.02), GLS ([-17.6±3.4]% vs[-22.3±3.0]%, P < 0.01), GCS([-28.4±6.0]% vs[-31.5±2.7]%, P=0.01), and the end-diastolic LV chamber volume ([73.8±18.4] mL vs[92.0±26.2] mL, P=0.01) were observed in case group using RT-3DE. All 3D-SDI indices reflecting LV dyssynchrony were significantly greater in the case group than those in the healthy controls (P < 0.01). The patients receiving high anthracycline dose were found to have increasedTmsv16-SD% ([7.7±5.5]% vs[3.5±1.2]%, P < 0.01) andTmsv16-Dif%(28.2±18.0 vs 11.7±4.3, P=0.004) (20.83%[15.09%, 49.71%] vs 13.75%[7.10%, 15.26%], P=0.02) compared with those in the low dose group, while 3D-STI strain parameters failed to distinguish the two subgroups.
RT-3DE is a valuable modality to sensitively detect decreased systolic dysfunction and mechanical dyssynchrony in long-term cancer survivors after anthracycline therapy, and Tmsv16-Dif% may be a better index to further differentiate the deteriorating dyssynchrony in survivors exposed to high dose anthracycline from those treated with low dose.
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