Anthracycline‐induced cardiotoxicity on regional myocardial work and left ventricular mechanical dispersion in adolescents and young adults in post‐lymphoma remission

Figures

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  FIGURE 1. Heatmap for treatment exposure. Cumulative doses in mg/m2. Corticosteroids (prednisone or dexamethasone) are recorded as prednisone‐equivalent. Vinkaalcaloids: vinblastin, vincristin, vinorelbin. Anthracyclines: daunorubicine or doxorubicine. Type II topoisomerase inhibitor: etoposide. Alkylating agents: bendamustin, carmustin, cyclophosphamide, dacarbazin, ifosfamide, melphalan or procarbazin. Anti‐metabolites: cytarabin, gemcitabin, 6‐mercaptopurin, methotrexate or 6‐thioguanin. Monoclonal antibodies (mAb): brentuximab or rituximab. # Non Hodgkin lymphomas.

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  FIGURE 2. Longitudinal and circumferential strain. Longitudinal strain and circumferential strains (CS) in childhood lymphoma survivors (red curve) and controls (blue curve). Circumferential strain is displaced as basal and apical segments. Longitudinal strains are displaced as global longitudinal strain (GLS), sub‐endocardial and sub‐epicardial layers. Difference between groups: p < 0.05.

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  FIGURE 3. Left ventricular twisting mechanics. Twist and untwist mechanisms in childhood lymphoma survivors (red curves) and controls (blue curves). (A) Basal rotation, (B) apical rotation and (C) twist, function of time (% of systolic duration). (D) Twist –untwist rate, function of time (% of systolic duration). Difference between groups: p < 0.05.

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  FIGURE 4. Myocardial work and its components. Noninvasive myocardial work estimation obtained from echocardiography. The left ventricle (LV) pressure–strain loop (PSL) is generated as a function of time of global longitudinal strain and systolic blood pressure, integrated to with the timing of aortic and mitral valve opening and closure. The area of the pressure–strain loop then provides the global myocardial work index (MWI) (at the left side). Global myocardial work efficiency (MWE) is then obtained by dividing the global constructive myocardial work (MCW) by the sum of both MCW and global myocardial wasted work (MWW). All global values are derived from averages of their segmental values.

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  FIGURE 5. Segmental myocardial work index from the construction of left ventricular Pressure‐Strain loops. These 18 figures represent, for each line, the 3 (A3C), 2 (A2C), and 4 (A4C) chambers views, using the same coding with childhood lymphoma survivors (red curves) and controls (blue curves) on pressure strain loops (PSL). The area of the pressure–strain loops corresponds to the segmental myocardial work index (MWI). In each PSL segment, p < 0.05 indicates a significant difference with the corresponding segment of the control group.