二维斑点追踪成像评价乳腺癌曲妥珠单抗化疗亚临床心脏毒性的价值

Evaluation of subclinical cardiotoxicity associated with trastuzumab chemotherapy in patients with breast cancer by two-dimensional speckle tracking imaging

目的应用二维斑点追踪成像(2D-STI)评估乳腺癌患者曲妥珠单抗化疗周期中心室收缩功能的早期改变,探讨2D-STI在评价化疗相关早期亚临床心脏毒性中的应用价值。方法选取在我院接受曲妥珠单抗化疗的HER-2阳性乳腺癌患者89例,共行3个化疗周期(即T1、T2、T3期),每个化疗周期为3周;根据患者化疗期间是否发生心脏毒性分为心脏毒性组22例和无心脏毒性组67例。于化疗前(T0期)和T1、T2、T3期分别行超声心动图检查,测量左室和右室常规超声心动图参数;应用2D-STI测量左室和右室整体纵向峰值应变(LVGLS、RVGLS)、左室周向峰值应变(LVGCS)。以化疗过程中出现心脏毒性为临床结局,应用Logistic回归分析和ROC曲线分析T1期时各参数对化疗亚临床心脏毒性的预测价值。结果心脏毒性组T2、T3期左室射血分数(LVEF)及T1、T2、T3期LVGLS、LVGCS、RVGLS均明显低于无心脏毒性组,差异均有统计学意义(均P<0.05)。心脏毒性组T2期LVEF低于T0期的18%,T1期、T2期LVGLS、LVGCS和RVGLS均显著低于T0期,差异均有统计学意义(P<0.05)。ROC曲线和Logistic回归分析表明T1期RVGLS联合LVGLS是预测乳腺癌化疗相关早期亚临床心脏毒性的最佳指标,其诊断敏感性为98%,特异性为75%。结论无明显LVEF降低的曲妥珠单抗化疗乳腺癌患者,其T1期LVGLS和RVGLS均已减低,2D-STI有助于早期发现化疗相关的亚临床心脏毒性,对改善乳腺癌患者临床结局和预后具有重要临床价值。

ObjectiveTo evaluate the early changes of ventricular systolic function in patients with breast cancer by two-dimensional speckle tracking imaging(2 D-STI)during chemotherapy with trastuzumab,and to explore the value of 2 D-STI in the evaluation of chemotherapy-related early subclinical cardiotoxicity.MethodsA total of 89 patients with HER-2 positive breast cancer who were diagnosed in our hospital and received trastuzumab chemotherapy were selected.There were 3 chemotherapy cycles,each of which lasted for 3 weeks.According to whether cardiotoxicity happened during the chemotherapy cycle,89 patients were divided into cardiotoxicity group(n=22)and non-cardiotoxicity group(n=67).The baseline level before chemotherapy(T0),the first cycle(T1),the second cycle(T2)and the third cycle(T3)were examined by echocardiography,and the routine echocardiography parameters were measured.The global longitudinal peak strains of left ventricle(LVGLS)and right ventricle(RVGLS)were measured by 2 D-STI.With the occurrence of cardiotoxicity in the course of chemotherapy as the clinical outcome,Logistic regression analysis and ROC curve analysis were used to analyze the predictive value of the parameters on the T1 cardiotoxicity associated with chemotherapy.ResultsLeft ventricular ejection fraction(LVEF)in T2,T3 and LVGLS,LVGCS,RVGLS in T1,T2,T3 of cardiotoxicity group were significantly lower than those of non-cardiotoxicity group(all P<0.05). LVEF in T2 of cardiotoxicity grou was lower than 18% of T0,while LVGLS,LVGCS and RVGLS in T1 and T2 were significantly lower than those in T0(all P<0.05).ROC curve and Logistic regression analysis showed that RVGLS combined with LVGLS in T1 was the best index to predict early subclinical cardiotoxicity associated with chemotherapy,the diagnostic sensitivity and specificity were 98% and 75%,respectively.ConclusionIn patients with breast cancer treated with trastuzumab who had no significant decrease in LVEF,LVGLS and RVGLS in T1 had been decreased. 2 D-STI is helpful for the early detection of chemotherapy-related subclinical cardiotoxicity.