Session Item

Treatments-related cardiotoxicity is a critical issue in long term lymphoma survivors, particularly at young age, and its early identification is fundamental to prevent clinically relevant cardiac events. Our purpose is to investigate for early detection of subclinical chemo and radiation-induced changes in left ventricular function using a complete echocardiographic assessment including 2-dimension global longitudinal strain (2D-GLS), which seems to be an effective tools in detecting preclinical systolic changes to the cardiac funtion even when the ejection fraction is preserved.

CARDIOCARE is a project consisting in a monocentric prospective observational study, approved by the ethic committee of our hospital (approval number: CS/370); Patients included in the study were clustered in two groups according to the treatment received: with chemotherapy alone (CT-alone) or with chemotherapy + mediastinal radiotherapy (CMT). Patients aged 18-70, affected with either Hodgkin or diffuse large B-cell/primary mediastinal lymphomas were eligible. Patients received a complete echocardiographic assessment including 2D-GLS at baseline, after chemotherapy, after radiotherapy (if contemplated), and 3 months after end of treatment. Paired samples T test correlations were applied to evaluate 2D-GLS changes at each time-point. The cumulative dose of anthracycline and the adsorbed dose of whole heart and cardiac substructures (coronaries, chambers and valves) were assessed for each patient. All patients signed an informed consent before the enrollment.

Eighty-two patients (45 in CT-alone group and 37 in CMT group) have completed the observational program and were included in this analysis. No patients experienced a significant reduction of the left ventricular (LV) ejection fraction during the entire observational period. A significant reduction of 2D-GLS was seen after chemotherapy in the overall population (GLS_baseline: -20.18 vs GLS_post-CT: -19.41, p =0.01). Age at treatment >40 (p =0.04), chemotherapy cycles >4 (p =0.001) and cumulative anthracycline dose >450 mg (0.01) were all predictors of significant GLS impairment after CT. After mediastinal RT, we observed a clinically significant reduction (defined as a relative reduction >8% compared with the previous evaluation) of 2D-GLS  in patients receiving: A) maximum dose to interventricular septum and to lateral wall of the LV >8 Gy (p =0.027 in both cases); B) mean dose to whole heart >4 Gy (p = 0.015) and mean dose ≥2 to interventricular septum (p = 0.05) and to whole LV (0.05). 

2D-GLS seems a promising tool to detect early cardiotoxicity in lymphoma patients. Our results suggest a correlation of both anthracyclines and radiation dose with preclinical heart damage. In particular, we identified RT threshold doses for GLS impairment that could help physicians to optimize the treatment when planning mediastinal RT in lymphoma patients.