Chemotherapy induced- right ventricular dysfunction in non-Hodgkin lymphoma: a 3D echocardiographic study

Background Although highly efficient, RCHOP (rituximab, cyclophosphamide, doxorubicin, oncovin, prednisone) chemotherapy in non-Hodgkin's lymphoma (NHL) is limited by the risk of cardiotoxicity. Despite the prognostic value of right ventricular (RV) function in mortality and morbidity has been well established, its involvement in chemotherapy-induced cardiac dysfunction remains unclear. Aim To define new parameters able to detect early RV cardiotoxicity. Methods 58 patients (25 men, 63±11 years) with NHL scheduled for RCHOP, with three dimensional (3D) left ventricular (LV) ejection fraction (EF) >50%, were assessed at baseline, after 4th and 8th cycle for RV parameters: 3D EF, two dimensional (2D) global longitudinal strain (GLS) and free wall LS (FWLS), peak systolic annular velocity (S’), tricuspid annulus systolic excursion (TAPSE) and 2D fractional area change (FAC). Biomarkers (troponin I, NT-pro-BNP) were measured. Cardiotoxicity was defined as LVEF reduction below 50% or preserved LVEF with LV LS decrease more than 15% from baseline or increased troponin. Results 16 (28%) of patients developed LV cardiotoxicity (group 1) while 42 did not (group 2). There was a significant reduction of RVEF, GLS, and FWLS, but not of RV S’, FAC, and TAPSE, starting with the 4th cycle, with greater changes in group 1 vs. group 2 (see Table). RVEF reduction correlated with changes of GLS, FWLS, RV S’ and troponin (r=0.511, r=0.603, r=0.331, r=-0.318, respectively; all p<0.05). Reduction of FWLS after the 4th cycle was the best independent predictor for the decrease of RVEF after the 8th cycle (R²=0.418, p<0.0001). FWLS decrease with more than 23% predicted cardiotoxicity after the 8th cycle (sensitivity of 84%; specificity of 77%). Conclusion 3D EF, 2D systolic deformation, and troponin I are able to detect early chemotherapy-induced right ventricular cardiotoxicity, and to predict further decline of RVEF in NHL patients. Thus, routine follow-up of RV function, along with the LV function, should be assessed at baseline, but also during and after chemotherapy.RV echo parameters and troponin values