Mario Levis, MD
No relationships to disclose.
SS 25 - Hematologic 2 - Translating Better Technology to Reduced Toxicity
Purpose/Objective(s):Treatment-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 function even when the ejection fraction is preserved.
Materials/Methods:CARDIOCARE is an ongoing project consisting in a monocentric prospective observational study, approved by the ethic committee of our hospital (approval number: CS/370); the planned accrual will finally include 100 patients, of which 50 treated with chemotherapy alone (CT-alone) and 50 treated with chemotherapy + mediastinal radiation therapy (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 radiation therapy (if contemplated), and 3 months after end of treatment. Paired samples T test correlations were applied to evaluate 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.
Results:Fifty-two patients (24 in CT-alone group and 28 in CMT group), out of 65 enrolled to date, 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 marginal reduction of 2D-GLS was seen after chemotherapy for patients in CT-alone arm (GLSbaseline: -19.24 vs GLSpost-CT: -18.42, p =0.06), but not for patients in CMT arm (median dose of anthracycline: 500 vs 400 mg, respectively). A marginal reduction of GLS after CT was observed also for patients with Age >40 (p =0.056) and receiving >4 cycles (p =0.055). After mediastinal RT, a significant reduction of 2D-GLS was found in patients receiving: A) maximum dose to interventricular septum >10 Gy (p =0.006), to lateral wall of the LV >8 Gy (p =0.002) and to whole LV >11 Gy (p =0.002); B) mean dose to whole heart >4.5 Gy (p = 0.007) and mean dose ≥2 to interventricular septum (p = 0.01), to lateral wall of the LV (p = 0.02) and to whole LV (0.006).
Conclusion:2D-GLS seems a promising tool to detect early cardiotoxicity in lymphoma patients. Preliminary results suggest a correlation of both anthracyclines and radiation dose with preclinical heart damage. The completion of CARDIOCARE study, and a future correlation with clinical events are needed to support and strengthen these preliminary assumptions.
No relationships to disclose.
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