背景:弥漫性大B细胞淋巴瘤(DLBCL)患者通常由于蒽环类化疗引起的心脏损害而预后不良,左心室舒张功能障碍早期表现。矢量流映射(VFM)是一种新颖的技术,其检测蒽环类化疗后左心室舒张功能障碍的有效性仍未得到证实。
目的:本研究使用向量流图(VFM)评估DLBCL患者蒽环类化疗后的左心室舒张功能。
方法:我们前瞻性纳入54例接受蒽环类化疗(至少4个周期)的DLBCL患者作为病例组,54例年龄和性别匹配的个体作为对照。在化疗前(T0)进行病例组VFM评估,4个化疗周期后(T4),在对照组中。测量包括基础,中间,和顶端段能量损失(ELb,ELm,ELa)和心室内压差(IVPDb,IVPDm,IVPDa)跨越四个舒张期:等容舒张(D1),快速填充(D2),缓慢填充(D3),和心房收缩(D4)。
结果:在T0时比较对照组和病例组之间的参数时,在一般数据中没有观察到显着差异,常规超声参数,和VFM参数(均P>0.05)。从T0到T4,ELa在整个舒张周期中显著增加(所有P<0.05);ELm仅在D4期间增加(所有P<0.05);ELb在D1、D2和D4期间增加(所有P<0.05)。所有IVPD测量(IVPDa,IVPDm,IVPDb)在D1和D4期间增加(均P<0.05),但在D2和D3期间减少(均P<0.05)。ELa-D4、IVPDa-D4和参数A之间存在显著正相关,e\',E/E,\'和LAVI(均r>0.5,均P<0.001)。ELa-D4IVPDa-D4与E/A呈负相关(均r<-0.5,均P<0.001)。观察到IVPDa-D1,IVPDa-D2与E,E/E\',和LAVI(0.3结论:VFM参数与常规舒张功能参数有一定的相关性,在评估左心室舒张功能方面有前景。此外,VFM参数对早期舒张功能变化表现出更大的敏感性,提示VFM可作为评价DLBCL患者化疗前后左心室舒张功能差异的新方法。
BACKGROUND: Patients with diffuse large B-cell lymphoma (DLBCL) often experience a poor prognosis due to cardiac damage induced by anthracycline chemotherapy, with left ventricular diastolic dysfunction manifesting early. Vector Flow Mapping (VFM) is a novel technology, and its effectiveness in detecting left ventricular diastolic dysfunction following anthracycline chemotherapy remains unverified.
OBJECTIVE: This study evaluates left ventricular diastolic function in DLBCL patients after anthracycline chemotherapy using vector flow mapping (VFM).
METHODS: We prospectively enrolled 54 DLBCL patients who had undergone anthracycline chemotherapy (receiving a minimum of 4 cycles) as the case group and 54 age- and sex-matched individuals as controls. VFM assessments were conducted in the case group pre-chemotherapy (T0), post-4 chemotherapy cycles (T4), and in the control group. Measurements included basal, middle, and apical segment energy loss (ELb, ELm, ELa) and intraventricular pressure differences (IVPDb, IVPDm, IVPDa) across four diastolic phases: isovolumic relaxation (D1), rapid filling (D2), slow filling (D3), and atrial contraction (D4).
RESULTS: When comparing parameters between the control and case groups at T0, no significant differences were observed in general data, conventional ultrasound parameters, and VFM parameters (all P > 0.05). From T0 to T4, ELa significantly increased throughout the diastole cycle (all P < 0.05); ELm increased only during D4 (all P < 0.05); and ELb increased during D1, D2, and D4 (all P < 0.05). All IVPD measurements (IVPDa, IVPDm, IVPDb) increased during D1 and D4 (all P < 0.05) but decreased during D2 and D3 (all P < 0.05). Significant positive correlations were identified between ELa-D4, IVPDa-D4, and parameters A, e\', E/e,\' and LAVI (all r > 0.5, all P < 0.001). Negative correlations were noted with E/A for ELa- D4 IVPDa-D4 (all r < -0.5, all P < 0.001). Positive correlations were observed for IVPDa-D1, IVPDa-D2 with E, E/e\', and LAVI (0.3
CONCLUSIONS: VFM parameters demonstrate a certain correlation with conventional diastolic function parameters and show promise in assessing left ventricular diastolic function. Furthermore, VFM parameters exhibit greater sensitivity to early diastolic function changes, suggesting that VFM could be a novel method for evaluating differences in left ventricular diastolic function in DLBCL patients before and after chemotherapy.