Prediction of Cardiovascular Adverse Events in Patients Treated with R-CHOP Regimens by 3D Transthoracic Echocardiography

Background: Patients treated for lymphoma are at risk of cardiovascular adverse events. Global longitudinal strain (GLS) and global circumferential strain (GCS) were reported for predicting cardiovascular adverse events in patients treated with doxorubicin. However, the prognostic value of RV ejection fraction by 3D transthoracic echocardiography (3D TTE) have not been elucidated yet. We hypothesized that RV echocardiography parameters increases the sensitivity for predicting the later CAE. Methods: In this retrospective study, ninety-six patients with diffuse large B-cell lymphoma with normal cardiac function treated with R-CHOP regimen were studied between January 2013 and January 2015 by 3D TTE. Basic demographic data, oncology and echocardiography parameters were measured. The main outcomes were the proportion of patients with grade 3–4 cardiovascular adverse events (CAE). The association of pre-chemotherapy and post-chemotherapy echocardiography parameters with CAEs was analyzed using proportional hazard analysis. Results: Over a median follow-up period of 6.1 years (range, 4.9-7.6 years) after the completion of chemotherapy, 18 of 96 patients (19%) experienced CAEs. Univariate predictors of CAE (P < .05) were LVGLS, LVGCS, RVEF, and RVESV. Multivariate analysis of all significant univariate variables showed that RVEF (hazard ratio, 0.848; 95% confidence interval,0.785–0.916; P < .001) were significantly and independently associated with CAE. Stepwise analysis of the multivariate associations showed an increase in the global x2 value after adding LVEF (P < .001) to significant clinical variables. Conclusion: LVGLS and RVEF were significantly and independently associated with CAE in patients. Adding RVEF to other clinical variables provided incremental prognostic information.