Early anthracycline‐induced cardiotoxicity monitored by echocardiographic Doppler parameters combined with serum hs‐cTnT

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 34; no. 11; pp. 1593 - 1600
• Main Authors: Zhang, Chu‐Jie, Pei, Xiao‐Li, Song, Fei‐Yan, Guo, Ye, Zhang, Qun‐Ling, Shu, Xian‐Hong, Hsi, David H., Cheng, Lei‐Lei
• Format: Journal Article
• Language: English
• Published: United States 01-11-2017
• Subjects: Adult; Aged; anthracycline; Anthracyclines - adverse effects; cardiotoxicity; Cardiotoxicity - blood; Cardiotoxicity - etiology; Cardiotoxicity - physiopathology; diffuse large B‐cell lymphoma; echocardiography; Echocardiography, Doppler - methods; Female; high‐sensitivity cardiac troponin T; Humans; Lymphoma, Large B-Cell, Diffuse - drug therapy; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Troponin T - blood; Troponin T - drug effects; Young Adult; high-sensitivity cardiac troponin T; cardiotoxicity; diffuse large B-cell lymphoma; anthracycline; echocardiography
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.13704

Purpose
As growing numbers of long‐term cancer survivors faced with the cardiac side effects by anthracycline treatment, it is necessary to explore the optimal monitoring method for the early detection of cardiac toxicity.
Methods
We conducted a retrospective analysis of 82 consecutive patients with diffuse large B‐cell lymphoma treated with chemotherapy. Echocardiographic Doppler imaging‐derived Tei index and mitral annular peak systolic velocity (Sm) measured by tissue Doppler imaging TDI, serum high‐sensitivity cardiac troponin T (hs‐cTnT) levels, and left ventricular ejection fraction (LVEF) by multigated radionuclide angiography (MUGA) were obtained before, after 2–4, and after 6–8 chemotherapy cycles. Cardiotoxicity was defined as a relative reduction of LVEF ≥10% from the baseline or LVEF <50% as measured by MUGA.
Results
Following chemotherapy, 24 (29.3%) patients developed detectable cardiac abnormality during the treatment. Five (6.1%) patients' cardiac function changed from normal baseline LVEF to <50% after the chemotherapy. Echocardiographic pulse wave Doppler Tei index (PW Tei index) (baseline 0.347 ± 0.115 vs 2–4 cycles 0.459 ± 0.161 vs 6–8 cycles 0.424 ± 0.139, P = .000) inversely correlated with systolic (P < .001) and diastolic dysfunction (P < .001). Serum hs‐cTnT levels increased significantly following chemotherapy after 2–4 cycles of chemotherapy with anthracycline. The increase in PW Tei index of 0.095 [sensitivity, 69.2%; specificity, 64.5%; area under the curve (AUC) = 0.697; P = .005] and the Sm < 13.65 cm/s (sensitivity, 66.7%; specificity, 71%; AUC = 0.682; P = .009) combined with elevation of serum hs‐cTnT level of 0.0075 ng/mL (sensitivity, 69.2%; specificity, 83.9%; AUC = 0.790; P < .001) after 2–4 chemotherapy cycles from the baseline values can reliably predict cardiotoxicity.
Conclusions
We demonstrated that echocardiographic PW Doppler‐derived Tei index, and TDI‐derived Sm, combined with serum hs‐cTnT level can be obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy.