斑点追踪技术评价蒽环类药物对乳腺癌患者左室心肌的早期损害

Evaluation of early myocardial dysfunction of left ventricle in patients with breast cancer after receiving anthracyclines by speckle tracking imaging

目的:探讨二维斑点追踪成像技术(2D-STI)检测蒽环类药物对乳腺癌患者左室心肌功能早期损害的应用价值。方法:32例乳腺癌术后以表柔比星为主进行化疗的女性患者为化疗组,分别于化疗前(T0)、第3个周期结束后(T1)及第6个周期结束后(T2)进行常规二维超声心动图检查,并记录左室舒张末内径(LVDd)、收缩末内径(LVDs)、室间隔厚度(IVSd)、左室后壁厚度(LVPWd)、左室射血分数(LVEF)、二尖瓣口舒张早、晚期峰值(Em、Am)、二尖瓣环舒张早期速度(e’),采集左室心尖四腔、长轴、二腔切面及二尖瓣水平、乳头肌水平、心尖部短轴切面动态图像,采用2D-STI软件获得左室收缩期整体纵向应变(GLS)、整体圆周应变(GCS)及整体径向应变(GRS),23例健康女性志愿者为正常对照组。利用受试者工作特征(ROC)曲线评价各应变参数检测左室功能早期损害的灵敏度和特异度。结果:①化疗组(T0、T1、T2)的常规超声心动图参数LVDd、LVDs、IVSd、LVPWd及LVEF与正常对照组比较,差异无统计学意义,T2的Em/Am、e’、Em/e’较正常对照组和T0降低,差异有统计学意义(P<0.05);②T1、T2的GLS较正常对照组和T0明显降低,差异均有统计学意义(P均<0.05),而T1、T2间比较,差异无统计学意义;T2的GCS亦较正常对照组和T0明显降低,差异具有统计学意义(P<0.05)。ROC曲线显示:T1的GLS曲线下面积为0.832,以-14.1%为截断值时,其灵敏度为83.4%,特异度为85.2%,T2的GLS曲线下面积为0.906,以-13.8%为截断值时,其灵敏度为92.2%,特异度为83.7%;T2的GCS曲线下面积为0.577,以-20.5%为截断值时,其灵敏度为63.0%,特异度为57.4%。结论:GLS检测蒽环类药物对心肌损害的灵敏度及特异度均最佳,可作为早期监测乳腺癌患者蒽环类药物化疗后左室亚临床心功能损害的敏感参数。

Objective:To investigate the value of two-dimensional speckle tracking imagine(2D-STI)in detecting the early myocardial dysfunction of left ventricular in patients with breast cancer after receiving drug treatment with anthracyclines.Methods:Thirty-two female patients with breast cancer were enrolled in our study.After surgery,all the patients were treated with epirubicinbased chemotherapy,besides,two-dimensional echocardiography was performed within one week before chemotherapy(T0),one week after the end of the third cycle(T1),and one week after the sixth cycle was finished(T2).Routine echocardiographic parameters including left ventricular end diastolic diameter(LVDd),end systolic diameter(LVDs),interventricular septum thickness at diastole(IVSd),left ventricular posterior wall thickness at diastole(LVPWd),left ventricular ejection fraction(LVEF),mitral valve predilatation and late peak(E_m,A_m),and mitral annular velocity(e’)were obtained.Two-dimensional images were defined as apical four-chamber,long-axis,two-chamber views,and the papillary muscles and apical left ventricular short-axis from the base.The images were stored for off-linc analysis of 2D speckle-tracking myocardial strain.Global peak longitudinal,circumferential and radial 2D systolic strain(GLS,GCS,GRS)were measured.Another twenty-three healthy female volunteers were collceted as control group.ROC curve was used to evaluate the sensitivity and specificity of each strain parameter to evaluate the early impairment of left ventricular function.Results:①LVDd,LVDs,IVSd,LVPWd,and LVEF showed no significant decrease compared with control group(P>0.05),while E_m/A_m,e’,and E_m/e’in T2 were significantly lower than those in T0 and control group,the difference was statistically significant(P<0.05).②GLS in T1 and T2 were significantly lower than those in T0 and control group,the difference was statistically significant(P<0.05),but there was no statistical significance between T1 and T2(P>0.05).The GCS in T2 was significantly lower than that in T0 and contol group(P<0.05).The ROC curves showed that GLS as the best predictor.The area under ROC(AUC)of GLS in T1 was0.832,and its optimal cut-off value was-14.1%,with a sensitivity of 83.4%and specificity of 85.2%,AUC of GLS in T2 was 0.906,and its optimal cut-off value was-13.8%,with a sensitivity of 92.2%and specificity of 83.7%,AUC of GCS in T2 was 0.577,and its optimal cut-off valur wsa-20.5%,with a sensitivity of 63.0%and specificity of 57.4%.Conclusion:GLS was the best indicator of subsequent cardiotoxic events.Therefore,GLS can be used as a sensitive parameter to devaluate subclinical left ventricular myocardial dysfunction in patients with breast cancer after receiving anthracycline therapy.