Abstract
BACKGROUND: Anthracycline-induced cardiotoxicity (CTX) requires close monitoring in lymphoma patients. Increased myocardial uptake of fluorine-18-fluorodeoxyglucose (18F-FDG) via positron emission tomography combined with computed tomography (PET/CT) may reflect early metabolic alterations and serve as a potential marker for CTX. OBJECTIVES: To evaluate changes in cardiac metabolism, myocardial strain, and troponin levels during anthracycline-based chemotherapy. METHODS: This prospective multicenter study included 55 adult lymphoma patients receiving anthracycline therapy. Echocardiography, high-sensitivity troponin, and cardiac 18F-FDG PET/CT were performed at baseline, mid-therapy, and posttreatment. CTX was defined as a ≥ 15% reduction in global longitudinal strain (GLS) from baseline. RESULTS: The mean age was 42 ± 16.7 years; 60% were female. Subclinical CTX occurred in 34% of patients, with a GLS decline observed after 3 months of follow-up, despite preserved left ventricular ejection fraction (LVEF). CTX was associated with older age, hypertension, diabetes, and dyslipidemia. Troponin levels were elevated in 33% but did not differ between the CTX and non-CTX groups. Myocardial 18F-FDG uptake increased in 49.1% of patients (≥ 30% standardized uptake value increase), without correlation with GLS or LVEF changes. CONCLUSIONS: GLS can detect early myocardial changes in lymphoma patients treated with anthracyclines, whereas increased 18F-FDG uptake on PET/CT did not correlate with ventricular dysfunction. The clinical significance of myocardial metabolic upregulation requires further investigation.