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Proper long-term follow-up is essential for malignant lymphoma survivors after-care. This study aimed to assess TTE parameters of potential subclinical cardiotoxicity and to examine their utility in diagnosing chronic cardiotoxicity. Improvement of the diagnostic process may precede the manifestation of cardiac adverse events. Main objective of the study was to improve the identification of cancer survivors in increased risk of treatment cardiotoxicity. To achieve this goal, utility of various echocardiography parameters was examined.In this retrospective study we analysed TTE of 167 subjects with speckle tracking according to the European Society of Echocardiography guidelines during the follow-up period. 88 of them were long-term lymphoma survivors diagnosed with malignant lymphoma between the years 1994\u20132015. Minimum follow up period was 5\u00a0years with the median of 10\u00a0years after anti-cancer treatment cessation. TTE were performed between the years 2017\u20132022 at cardio-oncology outpatient office during regular follow-up period. A total of 79 volunteers with no history of chronic heart failure (CHF) or decline in LVEF, 51 (64.6%) of whom were males, with the median age of 46 (16\u201358) years were included in the analysis as control group. Control subjects had various indications for TTE (e.g. preoperative examination, benign palpitations, or with well controlled arterial hypertension taking two antihypertensives at most). Ischemic heart disease was ruled out by stress test. None of the control subjects had history of stroke or chronic lower limb ischemia. All control subjects were considered clinically stable with no sign of cardiac impairment caused by primary disease. Both cancer survivors and control group were divided into subgroups based on LVEF: lower normal LVEF (53\u201361%), and higher normal LVEF (&gt;\u200961%). Survivors with lower normal LVEF (53\u201361%) had a statistically significant decline in GLS compared to those with higher normal LVEF (&gt;\u200961%). This phenomenon was not observed in control group indicating a possible additional diagnostic value of this parameter. Inclusion of GLS assessment in follow-up TTE examination of subjects with lower normal LVEF may improve the sensitivity of detection of chronic cardiotoxicity. Patients with declined GLS and lower normal LVEF are candidates for intensified follow-up to precede manifestation of cardiac adverse events.<\/jats:p>","DOI":"10.1038\/s41598-025-93933-2","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T17:31:29Z","timestamp":1742319089000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Utility of global longitudinal strain in early identification of chronic cardiotoxicity in asymptomatic long-term malignant lymphoma survivors with normal left ventricle ejection fraction"],"prefix":"10.1038","volume":"15","author":[{"given":"Eva","family":"Rihackova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Rihacek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubos","family":"Boucek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Vyskocilova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubomir","family":"Elbl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"93933_CR1","doi-asserted-by":"publisher","first-page":"1243531","DOI":"10.3389\/fcvm.2023.1243531","volume":"10","author":"E Rihackova","year":"2023","unstructured":"Rihackova, E., Rihacek, M., Vyskocilova, M., Valik, D. & Elbl, L. Revisiting treatment-related cardiotoxicity in patients with malignant lymphoma-a review and prospects for the future. Front. Cardiovasc. Med. 10, 1243531 (2023).","journal-title":"Front. Cardiovasc. Med."},{"issue":"1","key":"93933_CR2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002661","volume":"9","author":"MW Bloom","year":"2016","unstructured":"Bloom, M. W. et al. Cancer therapy-related cardiac dysfunction and heart failure: Part 1: Definitions, pathophysiology, risk factors, and imaging. Circ. Heart Fail. 9(1), e002661 (2016).","journal-title":"Circ. Heart Fail."},{"issue":"9","key":"93933_CR3","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/j.echo.2014.07.012","volume":"27","author":"JC Plana","year":"2014","unstructured":"Plana, J. C. et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of echocardiography and the European association of cardiovascular imaging. J. Am. Soc. Echocardiogr. 27(9), 911\u2013939 (2014).","journal-title":"J. Am. Soc. Echocardiogr."},{"issue":"4","key":"93933_CR4","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.jacc.2020.11.020","volume":"77","author":"P Thavendiranathan","year":"2021","unstructured":"Thavendiranathan, P. et al. Strain-guided management of potentially cardiotoxic cancer therapy. J. Am. Coll Cardiol. 77(4), 392\u2013401 (2021).","journal-title":"J. Am. Coll Cardiol."},{"issue":"3","key":"93933_CR5","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/j.jcmg.2019.09.013","volume":"13","author":"L Ye","year":"2020","unstructured":"Ye, L. et al. Myocardial strain imaging by echocardiography for the prediction of cardiotoxicity in chemotherapy-treated patients: A meta-analysis. JACC Cardiovasc. Imaging. 13(3), 881\u2013882 (2020).","journal-title":"JACC Cardiovasc. Imaging."},{"issue":"1","key":"93933_CR6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21708","volume":"72","author":"RL Siegel","year":"2022","unstructured":"Siegel, R. L., Miller, K. D., Fuchs, H. E. & Jemal, A. Cancer statistics, 2022. CA Cancer J. Clin. 72(1), 7\u201333 (2022).","journal-title":"CA Cancer J. Clin."},{"issue":"Pt B","key":"93933_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2020.101733","volume":"71","author":"F Erdmann","year":"2021","unstructured":"Erdmann, F. et al. Childhood cancer: Survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol. 71(Pt B), 101733 (2021).","journal-title":"Cancer Epidemiol."},{"issue":"3\u20134","key":"93933_CR8","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1159\/000360238","volume":"132","author":"SE Lipshultz","year":"2014","unstructured":"Lipshultz, S. E. et al. Cardiotoxicity and cardioprotection in childhood cancer. Acta Haematol. 132(3\u20134), 391\u2013399 (2014).","journal-title":"Acta Haematol."},{"issue":"41","key":"93933_CR9","doi-asserted-by":"publisher","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","volume":"43","author":"AR Lyon","year":"2022","unstructured":"Lyon, A. R. et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur. Heart J. 43(41), 4229\u20134361 (2022).","journal-title":"Eur. 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Subclinical cardiac dysfunction in childhood cancer survivors on 10-years follow-up correlates with cumulative anthracycline dose and is best detected by cardiopulmonary exercise testing, circulating serum biomarker, speckle tracking echocardiography, and tissue doppler imaging. Front. Pediatr. 8, 123 (2020).","journal-title":"Front. Pediatr."},{"issue":"1","key":"93933_CR13","first-page":"34","volume":"101","author":"WD Lewis","year":"2020","unstructured":"Lewis, W. D., Lilly, S. & Jones, K. L. Lymphoma: Diagnosis and treatment. Am. Fam. Physician. 101(1), 34\u201341 (2020).","journal-title":"Am. Fam. Physician."},{"issue":"4","key":"93933_CR14","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1093\/ejechocard\/jen174","volume":"9","author":"A Evangelista","year":"2008","unstructured":"Evangelista, A. et al. European association of echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur. J. 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Cancer. 127(24), 4646\u20134655 (2021).","journal-title":"Cancer."},{"issue":"4","key":"93933_CR27","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/j.jaccao.2023.06.003","volume":"5","author":"R Merkx","year":"2023","unstructured":"Merkx, R. et al. Extensive cardiac function analyses using contemporary echocardiography in childhood cancer survivors: A Dccss Later study. JACC CardioOncol. 5(4), 472\u2013485 (2023).","journal-title":"JACC CardioOncol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-93933-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-93933-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-93933-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T17:31:36Z","timestamp":1742319096000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-93933-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["93933"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-93933-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,18]]},"assertion":[{"value":"19 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Informed consent was obtained from all subjects involved in this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent statement"}},{"value":"The study was conducted by the Declaration of Helsinki (revision 2008) and the Good Clinical Practice guidelines. The study protocol was approved by the local ethical board of the University Hospital Brno 03\u2013100,424\/EK.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institutional review board statement"}}],"article-number":"9372"}}