Abstract：
BACKGROUND: Left ventricular global longitudinal strain (LVGLS) has been recommended by current guidelines for diagnosing anthracycline-induced cardiotoxicity. However, little is known about the early changes in left atrial (LA) morphology and function in this population. Our study aimed to evaluate the potential usefulness of LA indices and their incremental value to LVGLS with three-dimensional echocardiography (3DE) in the early detection of subclinical cardiotoxicity in patients with lymphoma receiving anthracycline.
METHODS: A total of 80 patients with diffuse large B-cell lymphoma who received six cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline (T0), after four cycles (T1), and after the completion of six cycles of chemotherapy (T2). Left ventricular ejection fraction (LVEF), LVGLS, LA volumes, LA emptying fraction (LAEF), LA active emptying fraction (LAAEF), and LA reservoir longitudinal strain (LASr) were quantified with 3DE. Left atrioventricular global longitudinal strain (LAVGLS) was calculated as the sum of peak LASr and the absolute value of peak LVGLS (LAVGLS = LASr+|LVGLS|). LV cardiotoxicity was defined as a new LVEF reduction by ≥10 percentage points to an LVEF of ≤50%.
RESULTS: Fourteen (17.5%) patients developed LV cardiotoxicity at T2. LA volumes, LAEF, and LAAEF remained stable over time. Impairment of LASr (28.35 ± 5.03 vs. 25.04 ± 4.10, p < .001), LVGLS (-22.77 ± 2.45 vs. -20.44 ± 2.62, p < .001), and LAVGLS (51.12 ± 5.63 vs. 45.61 ± 5.22, p < .001) was observed by the end of the fourth cycle of chemotherapy (T1). Statistically significant declines in LVEF (61.30 ± 4.73 vs. 57.08 ± 5.83, p < .001) were only observed at T2. The relative decrease in LASr (ΔLASr), LVGLS (ΔLVGLS), and LAVGLS (ΔLAVGLS) from T0 to T1 were predictors of LV cardiotoxicity. A ΔLASr of >19.75% (sensitivity, 71.4%; specificity, 87.9%; area under the curve (AUC), .842; p < .001), a ΔLVGLS of >13.19% (sensitivity, 78.6%; specificity, 74.2%; AUC, .763; p < .001), and a ΔLAVGLS of >16.80% (sensitivity, 78.6%; specificity, 93.9%; AUC, .905; p < .001) predicted subsequent LV cardiotoxicity at T2, with the AUC of ΔLAVGLS significantly larger than that of ΔLVGLS (.905 vs. .763, p = .027). Compared to ΔLVGLS, ΔLAVGLS showed improved specificity (93.9% vs. 74.2%, p = .002) and maintained sensitivity in predicting LV cardiotoxicity.
CONCLUSIONS: LASr could predict anthracycline-induced LV cardiotoxicity with excellent diagnostic performance. Incorporating LASr into LVGLS (LAVGLS) led to a significantly improved specificity and maintained sensitivity in predicting LV cardiotoxicity.
METHODS: A total of 80 patients with diffuse large B-cell lymphoma who received six cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline (T0), after four cycles (T1), and after the completion of six cycles of chemotherapy (T2). Left ventricular ejection fraction (LVEF), LVGLS, LA volumes, LA emptying fraction (LAEF), LA active emptying fraction (LAAEF), and LA reservoir longitudinal strain (LASr) were quantified with 3DE. Left atrioventricular global longitudinal strain (LAVGLS) was calculated as the sum of peak LASr and the absolute value of peak LVGLS (LAVGLS = LASr+|LVGLS|). LV cardiotoxicity was defined as a new LVEF reduction by ≥10 percentage points to an LVEF of ≤50%.
RESULTS: Fourteen (17.5%) patients developed LV cardiotoxicity at T2. LA volumes, LAEF, and LAAEF remained stable over time. Impairment of LASr (28.35 ± 5.03 vs. 25.04 ± 4.10, p < .001), LVGLS (-22.77 ± 2.45 vs. -20.44 ± 2.62, p < .001), and LAVGLS (51.12 ± 5.63 vs. 45.61 ± 5.22, p < .001) was observed by the end of the fourth cycle of chemotherapy (T1). Statistically significant declines in LVEF (61.30 ± 4.73 vs. 57.08 ± 5.83, p < .001) were only observed at T2. The relative decrease in LASr (ΔLASr), LVGLS (ΔLVGLS), and LAVGLS (ΔLAVGLS) from T0 to T1 were predictors of LV cardiotoxicity. A ΔLASr of >19.75% (sensitivity, 71.4%; specificity, 87.9%; area under the curve (AUC), .842; p < .001), a ΔLVGLS of >13.19% (sensitivity, 78.6%; specificity, 74.2%; AUC, .763; p < .001), and a ΔLAVGLS of >16.80% (sensitivity, 78.6%; specificity, 93.9%; AUC, .905; p < .001) predicted subsequent LV cardiotoxicity at T2, with the AUC of ΔLAVGLS significantly larger than that of ΔLVGLS (.905 vs. .763, p = .027). Compared to ΔLVGLS, ΔLAVGLS showed improved specificity (93.9% vs. 74.2%, p = .002) and maintained sensitivity in predicting LV cardiotoxicity.
CONCLUSIONS: LASr could predict anthracycline-induced LV cardiotoxicity with excellent diagnostic performance. Incorporating LASr into LVGLS (LAVGLS) led to a significantly improved specificity and maintained sensitivity in predicting LV cardiotoxicity.
摘要：
背景：目前的指南已推荐诊断蒽环类药物引起的心脏毒性的左心室整体纵向应变（LVGLS）。然而,对该人群中左心房(LA)形态和功能的早期变化知之甚少.我们的研究旨在通过三维超声心动图（3DE）评估LA指标及其对LVGLS的潜在有用性，以早期发现接受蒽环类药物的淋巴瘤患者的亚临床心脏毒性。
方法：共80例弥漫性大B细胞淋巴瘤患者接受6个周期的蒽环类药物治疗。在基线（T0）进行超声心动图检查，在四个周期（T1）之后，化疗完成6个周期后(T2)。左心室射血分数(LVEF),LVGLS,洛杉矶卷，洛杉矶排空分数（LAEF），洛杉矶主动排空分数（LAAEF），用3DE量化LA储层纵向应变（LASr）。左房室整体纵向应变(LAVGLS)计算为LASr峰值和LVGLS峰值的绝对值之和(LAVGLS=LASr+|LVGLS|)。LV心脏毒性定义为新的LVEF降低≥10个百分点至LVEF≤50%。
结果：14例（17.5%）患者在T2时出现左心室心脏毒性。洛杉矶卷，LAEF,随着时间的推移，LAAEF保持稳定。LASr减值（28.35±5.03与25.04±4.10，p<.001)，LVGLS（-22.77±2.45vs.-20.44±2.62，p<.001)，和LAVGLS（51.12±5.63vs.在化疗的第四周期（T1）结束时观察到45.61±5.22，p<.001）。LVEF的统计学显着下降（61.30±4.73vs.57.08±5.83，p<.001）仅在T2时观察到。LASr的相对减少(ΔLASr)，LVGLS(ΔLVGLS),从T0到T1的LAVGLS（ΔLAVGLS）是LV心脏毒性的预测因子。ΔLASr>19.75%(灵敏度，71.4%；特异性，87.9%;曲线下面积(AUC),.842；p<.001)，aΔLVGLS>13.19%(灵敏度，78.6%;特异性,74.2%；AUC，.763；p<.001)，ΔLAVGLS>16.80%(灵敏度，78.6%;特异性,93.9%;AUC,.905；p<.001）预测了T2时随后的LV心脏毒性，ΔLAVGLS的AUC显着大于ΔLVGLS的AUC（.905vs..763，p=.027）。与ΔLVGLS相比，ΔLAVGLS显示出改善的特异性（93.9%vs.74.2%,p=.002）并保持预测LV心脏毒性的敏感性。
结论：LASr可以预测蒽环类药物诱导的LV心脏毒性，具有良好的诊断性能。将LASr并入LVGLS(LAVGLS)导致在预测LV心脏毒性方面显著提高的特异性和维持的敏感性。
方法：共80例弥漫性大B细胞淋巴瘤患者接受6个周期的蒽环类药物治疗。在基线（T0）进行超声心动图检查，在四个周期（T1）之后，化疗完成6个周期后(T2)。左心室射血分数(LVEF),LVGLS,洛杉矶卷，洛杉矶排空分数（LAEF），洛杉矶主动排空分数（LAAEF），用3DE量化LA储层纵向应变（LASr）。左房室整体纵向应变(LAVGLS)计算为LASr峰值和LVGLS峰值的绝对值之和(LAVGLS=LASr+|LVGLS|)。LV心脏毒性定义为新的LVEF降低≥10个百分点至LVEF≤50%。
结果：14例（17.5%）患者在T2时出现左心室心脏毒性。洛杉矶卷，LAEF,随着时间的推移，LAAEF保持稳定。LASr减值（28.35±5.03与25.04±4.10，p<.001)，LVGLS（-22.77±2.45vs.-20.44±2.62，p<.001)，和LAVGLS（51.12±5.63vs.在化疗的第四周期（T1）结束时观察到45.61±5.22，p<.001）。LVEF的统计学显着下降（61.30±4.73vs.57.08±5.83，p<.001）仅在T2时观察到。LASr的相对减少(ΔLASr)，LVGLS(ΔLVGLS),从T0到T1的LAVGLS（ΔLAVGLS）是LV心脏毒性的预测因子。ΔLASr>19.75%(灵敏度，71.4%；特异性，87.9%;曲线下面积(AUC),.842；p<.001)，aΔLVGLS>13.19%(灵敏度，78.6%;特异性,74.2%；AUC，.763；p<.001)，ΔLAVGLS>16.80%(灵敏度，78.6%;特异性,93.9%;AUC,.905；p<.001）预测了T2时随后的LV心脏毒性，ΔLAVGLS的AUC显着大于ΔLVGLS的AUC（.905vs..763，p=.027）。与ΔLVGLS相比，ΔLAVGLS显示出改善的特异性（93.9%vs.74.2%,p=.002）并保持预测LV心脏毒性的敏感性。
结论：LASr可以预测蒽环类药物诱导的LV心脏毒性，具有良好的诊断性能。将LASr并入LVGLS(LAVGLS)导致在预测LV心脏毒性方面显著提高的特异性和维持的敏感性。
