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

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.