Risk factors for cardiac dysfunction caused by anthracycline drugs in the treatment of lymphoma and the early monitoring value of three-dimensional echocardiography

Anthracyclines (ANTs) are important chemotherapeutic drugs for the treatment of lymphoma. However, its cardiotoxicity poses a challenge to its continued use. The development of ARCD is influenced by multiple factors, making early detection challenging. Three-dimensional speckle tracking imaging (3D-STI) can quantitatively analyze myocardial strain by tracking the movement of myocardial spots. This study compared the parameters derived from conventional echocardiography, 3D-STI, and three-dimensional echocardiography at baseline (T0), 2 cycles of chemotherapy (T2) and 4 cycles of chemotherapy (T4), and analyzed the risk factors for ARCD. From January 2020 to December 2024, a total of 189 patients with non-Hodgkin lymphoma were recruited, all of whom received at least 4 cycles of ANT treatment. During chemotherapy and follow-up, 28 patients developed ARCD. Firth-penalized logistic regression demonstrated that age ≥65 years (aOR = 3.416, 95% CI: 1.241-9.913), hypertension (aOR = 3.051, 95% CI: 1.095-8.675), and cumulative ANT dose (aOR = 1.028, 95% CI: 1.017-1.040) were independently associated with an increased risk of ARCD. Conventional echocardiographic parameters, including LVEF, showed no significant changes. Compared with T0, right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were significantly increased at T4 (P<0.05), left ventricular global longitudinal strain (LVGLS) was significantly decreased at T2 (P<0.05), and left ventricular global circumferential strain (LVGCS) was significantly decreased at T4 (P<0.05). The absolute change in LVGLS from T0 to T2 (ΔLVGLS) was significantly and positively correlated with the cumulative ANT dose (R = 0.336, P<0.001). The cut-off value for predicting ARCD using ΔLVGLS was 3.5%. The area under the curve (AUC) was 0.852 and the respective sensitivity and specificity were 0.929 and 0.739. 3D-STI, particularly LVGLS, demonstrated significant value in the early identification of cardiac dysfunction in patients with lymphoma undergoing ANT treatment.