3D versus 2D echocardiography in early detection of chemotherapy induced systolic dysfunction in patients with non-Hodgkin lymphoma receiving CHOP protocol

Cardiotoxicity is a common adverse sequela of chemotherapy. CHOP protocol commonly used in management of Non-Hodgkin lymphoma is frequently complicated by cardiotoxic effects with a subsequent obvious increase of morbidity and demise. Despite its numerous shortcomings, estimation of the left ventricular ejection fraction (LVEF) by 2D echocardiography is still employed for detection of cardiotoxicity. The aim of our study was to assess the efficiency of 2D Echocardiography in comparison to 3D Echocardiography regarding the early recognition of chemotherapy-induced cardiotoxic effect on the left ventricular (LV) systolic function. This prospective observational study was conducted on 50 patients with Non-Hodgkin lymphoma who received the CHOP protocol. Patients were examined by both 2D and 3D echocardiography before the start of chemotherapy and 3 months later. The study was approved by the Ethical Committee of Cairo University and an informed consent was signed by the patients themselves or their first degree relatives. No significant LVEF variations were detected by the use of 2D Echocardiography after 3 months follow up. However, the mean strain values of 3D were significantly changed as global longitudinal strain (GLS), GAS, GRS and GCS were reduced by about 6%, 6.8%, 8.6% and 4.81% respectively, from their baseline values. 3D echocardiographic strain analysis by calculating GLS, GAS, GRS and GCS can accurately detect early myocardial dysfunction caused by cardiotoxic chemotherapy.