Two-dimensional speckle tracking echocardiography combined with high-sensitive cardiac troponin T in early detection and prediction of cardiotoxicity during epirubicine-based chemotherapy.
OBJECTIVE
To investigate whether alterations of myocardial strain and high-sensitive cardiac troponin T (cTnT) could predict future cardiac dysfunction in patients after epirubicin exposure.


METHODS
Seventy-five patients with non-Hodgkin lymphoma treated with epirubicin were studied. Blood collection and echocardiography were performed at baseline, 1 day after the third cycle, and 1 day after completion of chemotherapy. Patients were studied using echocardiography during follow-up. Global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were calculated using speckle tracking echocardiography. Left ventricular ejection fraction was analysed by real-time 3D echocardiography. Cardiotoxicity was defined as a reduction of the LVEF of ≥5% to <55% with symptoms of heart failure or an asymptomatic reduction of the LVEF of ≥10% to <55%.


RESULTS
Fourteen patients (18.67%) developed cardiotoxicity after treatment. GLS (-18.48 ± 1.72% vs. -15.96 ± 1.6%), GCS (-20.93 ± 2.86% vs. -19.20 ± 3.21%), and GRS (39.23 ± 6.44% vs. 34.98 ± 6.2%) were markedly reduced and cTnT was elevated from 0.0010 ± 0.0020 to 0.0073 ± 0.0038 ng/mL (P all < 0.01) at the completion of chemotherapy compared with baseline values. A >15.9% decrease in GLS [sensitivity, 86%; specificity, 75%; area under the curve (AUC) = 0.815; P = 0.001] and a >0.004 ng/mL elevation in cTnT (sensitivity, 79%; specificity, 64%; AUC = 0.757; P = 0.005) from baseline to the third cycle of chemotherapy predicted later cardiotoxicity. The decrease in GLS remained the only independent predictor of cardiotoxicity (P = 0.000).


CONCLUSIONS
GLS combined with cTnT may provide a reliable and non-invasive method to predict cardiac dysfunction in patients receiving anthracycline-based chemotherapy.
Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China; Department of Cardiology, Renji Hospital of Jiaotong University, Shanghai, China.
Yu
Y
Kang
Xiaoping
X
Xu
Leilei
L
Cheng
Lin
L
Li
Minmin
M
Sun
Haiyan
H
Chen
Cuizhen
C
Pan
Xianhong
X
Shu
D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D015251:Epirubicin / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000009:adverse effects; D000069283:Rituximab; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*; D014750:Vincristine / Q000009:adverse effects
D000903:Antibiotics, Antineoplastic; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; C571759:R-CHOP protocol; D020107:Troponin T; D015251:Epirubicin; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
Anthracycline-induced cardiotoxicity; High-sensitive cardiac troponin T; Left ventricular function; Two-dimensional speckle tracking echocardiography