P994Left and right rventricular relaxation abnormalities in early phase of chemotherapy


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Abstract

Purpose: to follow the patients treated by a combined cytostatic chemotherapy with tissue Doppler imaging, to asses the potential cardiotoxic effect on systolic and diastolic function of the heart at early phase after first cycles of chemotherapy and to identify the earliest signs of cardiotoxicity.Patients and methods: Thirty five patients with newly diagnosed non-Hodgkin's lymphoma were followed by transthoracic echocardiography prior to the ChT (A) and after completion of first series of ChT (B). Exclusion criteria: any organic diseases of the heart, lungs or circulation which may affect the systolic and diastolic function of the myocardium, poor image quality on echocardiography, previous cytostatic therapy, age over 75. Two of the pts died during the first series of ChT and 2 patients did not responded to initial ChT regime and their treatment had to be changed and prolonged. Thus, 31 patients (14M, 42.1 ± 11.3 y.o., 19-62) were enrolled into the final statistical analysis.Results: ChT: 3xCHOP, 7xBEACOPP, 9xPACEBO, 4xSTANFORD V, 8x“sequential” protocol (including PACEBO and mitoxantron. The cumulative dose of anthracyclins reached 353 ± 152 mg (120-600), i.e. 220 mg/m2 in average. Echo: left ventricle: no significant change occurred in LVEDD, LVESD, LVEF, PW-TDI peak systolic longitudinal velocity at mitral annulus and basal myocardial segments, mitral E and A, PW-TDI A'. Septal relaxation E' decreased from 9.7±2.8 to 7.8 ± 2.5 (p= 0.01). Right ventricle: the tricuspid annular PW-TDI peak systolic velocity decreased from 14.7±1.7 to 13.4±2.3 (p= 0.04).Conclusion: decrease in systolic right ventricular longitudinal velocity and a decrease in LV diastolic relaxation E'velocity at septal corner of mitral annulus were proved as the most acute changes after cardiotoxic chemotherapy.Discussion: RV damage may play a role in septal E' decrease.

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