ABSTRACT
Objective Both right and left ventricular function should be taken into account in the assessment of anthracycline (ATC)-induced cardiotoxicity.The aim of this study was to assess the subclinical dysfunction of right cardiac system in patients with newly diagnosed lymphoma who received ATC treatment by echocardiography.Methods A total of 74 patients with lymphoma who received ATC treatment were enrolled.Each patient underwent transthoracic echocardiographic examination before chemotherapy as well as after two,four and six cycles of ATC remedy.Right atrial (RA) and right ventricular (RV) end-diastolic area (EDA) and end-systolic area (ESA) were calculated.RV end-diastolic volume (EDV) and end-systolic volume (ESV),as well as RV ejection fraction (EF) were measured simultaneously.Tissue Doppler imaging (TDI) measurements of systolic and early or late diastolic myocardial velocities of RV free wall at tricuspid annuals were also analyzed.Two-dimensional speckle tracking echocardiography (2DSTE) was conducted to evaluate RV free wall strain along with strain rate.Results None of the echocardiographic parameters showed significant alteration after two and four cycles of chemotherapy compared with those at baseline (P＞0.05).At the end of the therapy (i.e.after six cycles of ATC treatment),there was still no statistical difference on TDI data aswell as 2DSTE measurements (P＞0.05).An unexpected finding was that the RAEDA((6.6±1.9) cm2 vs (7.7±2.4) cm2) and RAESA ((8.8±2.5) cm2 vs (10.8±2.8) cm2) revealed obvious dilatation after six cures of the regimen compared with those at baseline (P＜0.01).Similar morphologic characteristics displayed on the RVEDA ((14.1 ±3.4) cm2 vs (16.2±3.7) cm2) and RVESA ((7.9±1.9) cm2 vs (9.0±2.2) cm2) (P＜0.01)simultaneously.Furthermore,RVEDV ((29.8±10.5) ml vs (37.0±12.7) ml) and RVESV ((12.7±4.4) ml vs (15.0±5.2) ml),as well as RVEF ((59.4±5.8)％ vs (56.4±5.8)％),in patients with lymphoma presented statistically significant difference between basic state and the level after six cycles of chemotherapy (P＜0.01).Meanwhile,no marked change was detected on left ventricular ejection fraction(LVEF) throughout the follow-up period (P＞0.05).Conclusions Echocardiography can be used easily and noninvasively to assess right cardiac system subclinical dysfunction.ATC-induced cardiotoxicity of right cardiac system is firstly manifested as morphological changes than the measurements with novel echocardiographic techniques.In addition,RVEF expresses as a valuable parameter for assessing subtle RV impaired performance in patients with lymphoma received ATC therapy.
ABSTRACT
Introducción: El efecto de prostanoides inhalatorios sobre la función auricular derecha (AD) en hipertensión arterial idiopática (HAP) no ha sido estudiado. Objetivo: Evaluar cambios agudos en la función AD y función diastólica del ventrículo derecho en pacientes con HAP post uso de Iloprost inhalatorio. Métodos: Se incluyeron pacientes con HAP sin uso previo de prostanoides. Se realizó un ecocardiograma transtorácico basal y 30 min posterior a la inhalación de iloprost. Se midió dimensión AD, relación E/e' y strain de la AD por speckle tracking, registrando la onda negativa de contracción auricular (SaAD) y la onda positiva de la fase de reservorio (SsAD). Se midió el tiempo de inicio de la fase de reservorio AD durante el sístole ventricular. Resultados: Se estudiaron 16 pacientes (15 mujeres), con edad promedio 44 ± 7,8 años. Post Iloprost disminuyó el volumen AD (basal: 140ml, post Iloprost: 109 ml; p 0,008) y las presiones de llenado (E/e’ basal: 13, post Iloprost: 9,8; p 0,028). No se registraron diferencias en el SaAD (basal: -8,4%, post Iloprost: -8,5%; p 0,834). El SsAD fue mayor post Iloprost (basal: 8,6%, post Iloprost: 11,7%; p 0,002) iniciándose antes durante el sístole ventricular (basal: 445ms, post Iloprost: 368ms; p 0,001). Conclusión: Con Iloprost inhalatorio en pacientes con HAP se observa una reducción aguda en el tamaño de la AD y en las presiones de llenado del VD. La deformación durante la fase de reservorio de la AD aumenta y se inicia significativamente antes. Esto sugiere que el Iloprost podría mejorar en forma aguda el trabajo mecánico de la AD en paciente con HAP.
Background: The effects of inhaled prostanoids on right atrial (RA) function in patients with Pulmonary Arterial Hypertension (PAH) have not been studied. We evaluated acute changes in RA function and right ventricular diastolic function after inhaled iloprost. Methods: We included PAH patients without prior prostanoid treatment. A surface echocardiogram was performed at baseline and 30 minutes after iloprost inhalation. Measurements included RA dimensions, right E/e’ ratio and RA strain by speckle tracking, registering a RA contraction wave (RASa) and RA reservoir wave (RASs). RA time to peak of deformation during the reservoir phase was also measured. Results: We included 16 patients (15 females, aged 44±7.8 years. Post iloprost there was a reduction in RA volume (baseline: 140ml, post iloprost: 109ml; p 0.008) and right ventricular filling pressure (baseline E/e’: 13, post iloprost: 9.8; p 0.028). There was no difference in the magnitude of the RASa wave (baseline: -8.4%, post iloprost: -8.5%; p 0.834). The RASs wave was larger post iloprost (baseline: 8.6%, post iloprost: 11.7%; p 0.002), and began earlier (baseline RA time to peak of deformation during reservoir phase: 445ms, post iloprost: 368ms; p 0.001). Conclusion: Inhaled iloprost acutely reduces RA size and right ventricular filling pressure in patients with HAP It also significantly increases the magnitude of RA systolic deformation as well as making it occur earlier in RA filling phase. This suggests that iloprost might improve RA mechanical performance.