Abstract
OBJECTIVE: To evaluate the utility of real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI) for early detection of chemotherapy-induced cardiotoxicity in lymphoma patients, and to identify independent predictors of cardiotoxicity using these imaging parameters. METHODS: We conducted a single-center retrospective cohort study at The First People's Hospital of Changde City, enrolling 110 lymphoma patients who received anthracycline-based chemotherapy between January 2020 and January 2024. Echocardiographic assessments, including RT-3DE and 2D-STI, were performed before chemotherapy and within 72 hours after the 3rd and 6th cycles. Cardiotoxicity was defined as a ≥ 10% reduction in left ventricular ejection fraction (LVEF) or an LVEF < 50%. RESULTS: Baseline clinical characteristics showed significant differences in gender and hypertension between the cardiotoxic and non-cardiotoxic groups (both P < 0.05). RT-3DE revealed time-dependent changes, with LAEFa higher and LAEFa/LAEFt lower in the cardiotoxic group at 3 and 6 weeks post-chemotherapy, respectively (all P < 0.05). 2D-STI showed significant differences in LASct and LASr at 3 and 6 weeks (all P > 0.05). GEE analysis indicated that changes in LAEFa, LAEFp, LAEFt, LASr, LASct, and LVEF were driven by the time × group interaction effect (all P < 0.05). CONCLUSION: RT-3DE and 2D-STI are sensitive for early detection of anthracycline-induced cardiotoxicity in lymphoma patients. LA functional indices (LAEFa, LAEFp, LAEFt) and LA strain indices (LASr, LASct) may detect cardiotoxicity earlier than LVEF, suggesting their potential role in optimizing cardio-oncology monitoring strategies.