Assessment of Left Ventricular Function using a Two-Dimensional Speckle Tracking Echocardiography in Asymptomatic Survivors of Hodgkin’s Lymphoma in Long-Term Follow-Up

Abstract

Introduction: Two-dimensional speckle tracking echocardiography (2D-STE) is sensitive in the assessment of left ventricular (LV) systolic function and may aid in diagnosis of late cardiac effects in asymptomatic Hodgkin's lymphoma (HL) survivors in long-term follow-up. Methods: This is a cross-sectional study of 21 HL survivors previously treated with anthracyclines, with (8/21) or without-mediastinal (8/21) radiotherapy and no recurrence at least 3 years after treatment compared to age-matched 43 healthy volunteers. To assess long-term cardiac complications, we performed 12-lead electrocardiography and 2D transthoracic echocardiography. In addition to conventional echocardiographic parameters, we used tissue Doppler echocardiography for LV diastolic functions and 2D-STE for evaluating the global longitudinal strain (GLS) of the LV myocardium. Results: The mean age of the HL survivors was 40 +/- 15 years and the female sex was predominant (11/21). The average PR interval of the HL survivors was significantly longer (154.7 +/- 19.6 ms vs 133.8 +/- 13.9 ms, p<0.001) while the QTc interval was significantly shorter (383.8 +/- 18.7 ms vs 402.4 +/- 11.7 ms, p<0.001) than the control group. HL survivors had significantly impaired GLS compared to the control group (-193 +/- 2.6 vs-22.6 +/- 1.6, p<0.001). Thirteen of the HL survivors (61%) with normal LV ejection fraction had impaired GLS. The frequency of left ventricular diastolic dysfunction (LVDD) in the HL survivors group was significantly higher than that of the control group (52% vs 26%, p=0.015). Therefore, LVDD was detected in 61.5% of patients with a GLS <-20%. Conclusion: 2D-STE could be used in predicting late-onset subclinical cardiac side effects following treatment in asymptomatic HL survivors for long-term follow-up.