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

Abstract Background: Anthracycline generates progressive left ventricular dysfunction associated with a poor prognosis. Objectives: The purpose of this study was to evaluate whether layer-specific strain analysis could assess the subclinical left ventricular dysfunction after exposure to anthracycline. Methods: Forty-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. Results: Conventional 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. Conclusions: It 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.

摘要

背景：蒽环类药物（anthracycline）可引发进行性左心室功能不全，且预后不良。
研究目的：本研究旨在评估层特异性应变分析能否用于评估蒽环类药物暴露后亚临床左心室功能不全。
研究方法：本研究纳入42例接受蒽环类药物治疗的大B细胞非霍奇金淋巴瘤幸存者（化疗组），年龄为55.83±17.92岁；另纳入27名健康志愿者作为对照组，年龄为51.39±13.40岁。化疗组患者的表柔比星（epirubicin）累积剂量为319.67±71.71mg/m²，末次表柔比星给药至超声心动图检查的间隔时间为52.92±22.32个月。本研究分析了整体纵向应变（global longitudinal strain, GLS）、整体圆周应变（global circumferential strain, GCS）及整体径向应变（global radial strain, GRS），同时分析了心内膜下、心肌中层、心外膜下三层的纵向应变（LS-ENDO、LS-MID、LS-EPI）与圆周应变（CS-ENDO、CS-MID、CS-EPI）。跨壁应变梯度以心内膜下与心外膜下两层的收缩期峰值应变差值计算。本研究以p<0.05为差异具有统计学意义。
研究结果：两组患者的常规收缩及舒张功能参数均无显著差异。与对照组相比，化疗组患者的GCS与GLS显著降低。多层斑点追踪分析显示，化疗组患者的心内膜下层圆周应变、跨壁圆周应变梯度及三层纵向应变均显著降低。与之相反，两组的跨壁纵向应变梯度与径向应变无显著差异。
研究结论：本研究证实，蒽环类药物暴露后的长期幸存者存在心内膜下变形功能的选择性受损。多层斑点追踪超声心动图（multi-layer speckle tracking echocardiography）或可助力该高危患者队列的长期随访。