Cardiopulmonary Functional Profiles in Cancer Therapy-Related Cardiac Dysfunction Among Patients with Non-Hodgkin Lymphoma

Abstract

Background: Non-Hodgkin lymphoma (NHL) is associated with significant cardiovascular risks due to treatment-related toxicities, including cancer therapy-related cardiac dysfunction (CTRCD). While multimodality imaging, particularly echocardiography, is pivotal in monitoring cardiac function, the prognostic role of cardiopulmonary exercise testing (CPET) in predicting CTRCD remains underexplored. Methods: The prospective study enrolled 127 NHL patients, 72 men (56.7%) and 55 women (43.3%), with a median age of 62 years (range 34-83 years). The patients were assessed before initiating antitumor treatment and at six months follow-up using echocardiography and cardiopulmonary exercise testing. Results: Asymptomatic CTRCD occurred in 14.2% of NHL patients at six months of treatment. Patients with CTRCD exhibited significantly lower median work rates, volume of oxygen (VO₂) at the anaerobic threshold, and O₂ consumption efficiency, reflecting compromised metabolic and functional performance. Baseline peak oxygen consumption (VO₂ peak) positively correlated with left ventricle ejection fraction (LVEF) at six months, while VO₂ peak < 14 mL/kg/min was negatively associated with LVEF. Conclusions: Asymptomatic CTRCD was identified in 14.2% of NHL patients at six months, with lower work rates, VO₂ at the anaerobic threshold, and O₂ consumption efficiency, indicating impaired performance. Baseline peak oxygen consumption correlated positively with LVEF, highlighting CPET's potential for early CTRCD risk assessment.

Keywords: cancer therapy–related cardiac dysfunction; cardiopulmonary test; cardiotoxicity; heart failure.

Figure 1

Workflow chart of patient recruitment.

Figure 2

Heatmap of Spearman correlations linking initial cardiopulmonary parameters to left ventricular ejection fraction at 6-month follow-up. Note: CPET WR—work rate, VO₂/WR—volume of oxygen per work rate, VO₂ peak—peak oxygen uptake, VO₂ peak, %—predicted peak oxygen uptake, VE/VCO₂—ventilatory equivalent for carbon dioxide, VO₂ pulse—volume of oxygen per heart rate, VE/VCO₂ AT—ventilatory equivalent for carbon dioxide at anaerobic threshold, OUES—oxygen uptake efficiency slope, RER—respiratory exchange ratio, VO₂ < 14—peak oxygen consumption < 14 mL/kg/min, RER ≥ 1.10—respiratory exchange ratio ≥ 1.10, VE/VCO₂ > 30—ventilatory equivalent for carbon dioxide (VE/VCO₂) exceeds 30 during exercise, and FE VS—left ventricular ejection fraction.

Figure 3

CPET workload in study groups.

Figure 4

VO₂ at anaerobic threshold in study groups.

Figure 5

The distribution of patients with a VO₂ peak < 14 mL/kg/min in study groups. Note: NA, Not Available.