Incidence, Risk Factors and Early Prediction of Doxorubicin-Induced Cardiotoxicity by Global Longitudinal Strain and Cardiac Biomarkers in Indian Patients With Lymphoma: A Prospective Observational Study.

Abstract

Background: Detecting anthracyclines-induced cardiotoxicity before the onset of left ventricular dysfunction could enable the timely initiation of cardioprotective measures. 2D-Echocardiography (ECHO) with global longitudinal strain (GLS) and cardiac biomarkers are valuable for the early prediction of cardiotoxicity.

Objectives: We aimed to evaluate the predictive utility of 2D-ECHO-GLS and cardiac biomarkers exclusively in patients with lymphoma treated with a doxorubicin-based regimen.

Methods: The study included lymphoma patients ≥14 years of age of either sex who were planned for a doxorubicin-based regimen. All eligible patients underwent 2D-ECHO-GLS and cardiac biomarkers (troponin T and pro-brain natriuretic peptide) measurements at the baseline (V1), after 3^rd chemotherapy cycle (V2), and after treatment completion (V3). Incidence, risk factors, and early predictors for cardiotoxicity were assessed using SPSS software version 25. The study was registered with CTRI (CTRI/2021/07/034518).

Results: 40 patients (median age, 42 years) had evaluations available at all 3 time points. Three out of 40 (7.5%) patients developed cardiotoxicity at V3. Patients with cardiotoxicity had a significantly higher mean age (P = .045) and a greater incidence of hypertension (P = .012) than those without cardiotoxicity. At V2, the mean GLS threshold (-18.1%) and Δ GLS threshold ≥15% from baseline were significant early predictors of subsequent cardiotoxicity. Despite an exponential rise from V1 to V3, the cardiac biomarkers failed to predict cardiotoxicity.

Conclusions: Patients with lymphoma treated with doxorubicin-based regimens have a significant risk of developing cardiac dysfunction. A greater than 15% fall in GLS from baseline after 3^rd chemotherapy cycle could predict subsequent cardiotoxicity.