Prediction of Cardiovascular Adverse Events in Patients Treated with
R-CHOP Regimens by 3D Transthoracic Echocardiography
Abstract
Background: Patients treated for lymphoma are at risk of cardiovascular
adverse events. Global longitudinal strain (GLS) and global
circumferential strain (GCS) were reported for predicting cardiovascular
adverse events in patients treated with doxorubicin. However, the
prognostic value of RV ejection fraction by 3D transthoracic
echocardiography (3D TTE) have not been elucidated yet. We hypothesized
that RV echocardiography parameters increases the sensitivity for
predicting the later CAE. Methods: In this retrospective study,
ninety-six patients with diffuse large B-cell lymphoma with normal
cardiac function treated with R-CHOP regimen were studied between
January 2013 and January 2015 by 3D TTE. Basic demographic data,
oncology and echocardiography parameters were measured. The main
outcomes were the proportion of patients with grade 3–4 cardiovascular
adverse events (CAE). The association of pre-chemotherapy and
post-chemotherapy echocardiography parameters with CAEs was analyzed
using proportional hazard analysis. Results: Over a median follow-up
period of 6.1 years (range, 4.9-7.6 years) after the completion of
chemotherapy, 18 of 96 patients (19%) experienced CAEs. Univariate
predictors of CAE (P < .05) were LVGLS, LVGCS, RVEF, and
RVESV. Multivariate analysis of all significant univariate variables
showed that RVEF (hazard ratio, 0.848; 95% confidence
interval,0.785–0.916; P < .001) were significantly and
independently associated with CAE. Stepwise analysis of the multivariate
associations showed an increase in the global x2 value after adding LVEF
(P < .001) to significant clinical variables. Conclusion:
LVGLS and RVEF were significantly and independently associated with CAE
in patients. Adding RVEF to other clinical variables provided
incremental prognostic information.