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Right ventricular dysfunction in patients with diffuse large B-cell lymphoma undergoing anthracycline-based chemotherapy: a 2D strain and 3D echocardiography study

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Abstract

To investigate whether 2D strain and 3D echocardiography could early identify the impaired right ventricular (RV) function after anthracycline exposure. Sixty-one patients with diffuse large B-cell lymphoma treated with anthracycline were studied. Echocardiography was conducted at baseline, after the third cycle of the chemotherapy, after the completion of the chemotherapy, and follow-up at 10 months after the initiation of chemotherapy. RV global longitudinal strain (RV GLS) and RV free wall longitudinal strain (RV FWLS) were calculated using speckle tracking echocardiography. RV ejection fraction (RVEF) was analyzed by 3D echocardiography. RV systolic dysfunction was defined by ≥ 2 RV parameters below the threshold value, and cardiotoxicity was defined as a reduction in left ventricular EF > 10 to < 53%. After the third cycle of chemotherapy, only RV GLS was significantly decreased, while after the completion of the chemotherapy, RV GLS, RV FWLS, and RVEF were all significantly decreased compared with baseline measurements. At the end of follow-up, 9 patients (14.8%) were diagnosed with RV systolic dysfunction, and 16 patients (26.2%) had at least 1 abnormal RV function parameter. The proportion of RV systolic dysfunction was significantly higher in patients with cardiotoxicity than in patients without cardiotoxicity, yielding an odds ratio of 5.143. A percentage decrease in RV FWLS and RVEF were independent predictors of RV systolic dysfunction. Two-dimensional strain and 3D echocardiography are valuable methods for evaluating anthracycline-related impairment of RV function in DLBCL patients receiving chemotherapy. RV FWLS and RVEF are reliable predictors of RV systolic dysfunction.

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Funding

This study was funded by the Cangzhou Key Research & Developement Program (Grant No. 183302025).

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Authors and Affiliations

  1. Department of Ultrasound, Cangzhou People’s Hospital, Cangzhou, China

    Baozhen Wang, Yue Zhang, Xiaoyi Hao, Shan Yang, Hong Zhao & Qianqian Sun

  2. Medical Imaging Center, Cangzhou People’s Hospital, Cangzhou, China

    Yang Yu & Yue Wang

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  1. Baozhen Wang
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  2. Yang Yu
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  3. Yue Zhang
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  4. Xiaoyi Hao
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  5. Shan Yang
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  6. Hong Zhao
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  8. Yue Wang
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Correspondence to Xiaoyi Hao.

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Supplementary Information

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Supplementary Information 1 (TIF 7080 kb)

Supplementary Figure 1. Three-dimensional analysis of the RV: 3D echocardiography data sets are obtained in a dedicated apical 4-chamber RV-focused view (A). After anatomic landmarks are set, a four-chamber view (B) and short-axis view (C) are extracted from the 3D echocardiography data set for both end-diastolic (top) and end- end-systolic (bottom). After endocardial border are adjusted in these views, the 3D endocardial surface is calculated and rendered (D). RV = right ventricle.

Supplementary Information 2 (TIF 16125 kb)

Supplementary Figure 2. Bland-Altman analysis showed very good intra- and interobserver reproducibility for RV GLS, RV FWLS, and RVEF measurements. RVEF = right ventricle ejection fraction; RV FWLS = right ventricle free wall peak systolic longitudinal strain; RV GLS = right ventricle peak systolic global longitudinal strain.

Supplementary Information 3 (DOCX 15 kb)

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Wang, B., Yu, Y., Zhang, Y. et al. Right ventricular dysfunction in patients with diffuse large B-cell lymphoma undergoing anthracycline-based chemotherapy: a 2D strain and 3D echocardiography study. Int J Cardiovasc Imaging 37, 1311–1319 (2021). https://doi.org/10.1007/s10554-020-02120-z

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  • DOI: https://doi.org/10.1007/s10554-020-02120-z

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