AbstractBackgroundRituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP) chemotherapy in non‐Hodgkin's lymphoma (NHL) has risk of cardiotoxicity.PurposeTo determine the role of myocardial work and biomarkers in subclinical diagnosis and prediction of cardiotoxicity.MethodsThe 130 NHL patients (52 ± 9 years, 62% men) scheduled for RCHOP, with LVEF>50%, were evaluated at baseline, after third cycle and chemotherapy completion for 3D LVEF, 2D myocardial deformation (longitudinal, radial, circumferential strain ‐ LS, RS, CS) and myocardial work (global constructive work, waste work, work index and work efficiency ‐ GCW, GWW, GWI, GWE). NT‐pro‐BNP and troponin I were determined.ResultsAfter chemotherapy ended, 37 patients (28%) (group I) developed asymptomatic cardiotoxicity (8 mild form, 25 moderate form, 4 severe form); 93 patients (group II) did not. After third cycle, all patients had decreased LS, CS, RS, GCW, GWI, GWE and increased GWW, persistent after chemotherapy completion, with significant changes in group I. After third cycle, GWE and GCW were the best independent predictors for LVEF reduction; GWE decrease with>5% after third cycle predicted cardiotoxicity after chemotherapy completed (91% sensitivity, 94% specificity).ConclusionsIn NHL, myocardial work can diagnose subclinical cardiotoxicity and predict LVEF decline. These parameters should be used for sensitive evaluation of myocardial function during chemotherapy.