组织速度成像对蒽环类药物心脏毒性的评价

Evaluation of Anthracycline Antineoplastic Drugs Induced Myocardial Damage by Using Quantitative Tissue Velocity Imaging

目的探讨利用组织多普勒定量组织速度成像QTVI技术对蒽环类药物早期心脏毒性进行评估。方法 30例在江北人民医院化疗的肿瘤患者,所用化疗方案以表阿霉素(Epi)为主,表阿霉素总累计量(450±75)mg/m2,每个疗程治疗前进行组织多普勒定量组织速度成像和常规超声心动图检查。同时设健康对照组20例。常规超声心动图指标包括左室舒张末内径(LVDd),左室收缩末内径(LVDs),左室射血分数(LVEF),室间隔与左室后壁厚度(IVSTd、LVP-WTd),二尖瓣口血流速度(早期速度E、晚期速度A及两者比值E/A);定量组织速度成像测量二尖瓣环上左室侧壁及后间隔两个位点的峰值速度(收缩期峰值Vs、收缩期加速度a,舒张期峰值Ve)。结果与第一次治疗前对比,常规超声指标LVDd、LVDsI、VSTd、LVPWTd差别无统计学意义(P>0.05),左室射血分数在累积量达到450 mg/m2时差别有统计学意义(50.1±7.3与68.0±9.0,P<0.05)。舒张期指标E/A在累积量达到375 mg/m2时差别有统计学意义(0.71±0.14与1.20±0.21,P<0.05)。利用组织多普勒QTVI技术检测对比发现,收缩期指标Vs、a在累积量达300 mg/m2时差别有统计学意义([5.70±1.07)cm/s与(7.84±1.10)cm/s(、132±14)cm/s2与(219±31)cm/s2,P<0.05],舒张期指标Ve在累积量达到225 mg/m2差别有统计学意义([6.86±1.04)cm/s与(8.74±1.32)cm/s,P<0.05]。结论在监测表阿霉素心脏毒性上,组织多普勒超声心动图较常规超声心动图能较早期和较敏感发现心脏损害,且舒张功能的损害早于收缩功能。

Objective To evaluate the early cardiac toxicity cased by anthracycline antineoplastic drugs by using quantitative tissue velocity imaging（QTVI）. Methods Thirty tumor patients and 20 normal controls were enrolled in this study. The chemotherapy drugs was mainly with a total dose of （ 450 ± 75 ） mg/m^2 epirubicin. The conventional eehoeardiography and tissue Doppler echoeardiography QTVI parameters were measured before every treatment courses. The conventional eehoeardiography pa- rameters included left ventricular end-diastolic diameter（LVDd） ,left ventricular end-systolic diameter（LVDs） ,intermediate ven- tricttlar septal thickness （ IVSTd ）, left ventricular posterior wall diameter（ LVPWd ）, left ventrieular ejection fraction （ LVEF）, early and late wave of mitral valve flow（E/A） ;The tissue Doppler echoeardiography parameters included peak velocity during systole （Vs） systolic acceleration（a） and peak diastolic velocity（Ve）. Results Compared to baseline before the first period, there was no significant change in conventional echocardiography systolic parameters LVEDD, LVESD, IVST, LVPWd （ P 〉 0.05 ） ; LVEF changed significantly at total dose of 450 mg/m2 （ 50.1 ± 7.3 and 68.0 ±9.0, P 〈 0.05 ） ; the conventional eehoeardiography di- astolic parameter E/A changed significantly at total dose of 375 rag/m2 （0.71 ±0.14 and 1.20 ± 0.21,P 〈 0.05 ） ;While tissue Doppler eehocardiography QTVI parameters peak velocity during systole（Vs） and systolic acceleration （a） changed significantly at total of dose 300 mg/m2[（5.70±1.07） cm/s and （7.84±1.10） cm/s,（132±14） cm/s2 and （219 ±31） cm/s2,P〈 0.05] ,tissue Doppler eehoeardiography diastolic parameter peak diastolic veloeity（Ve） changed significantly at total of dose 225 mg/m2 [ （6.86 ± 1.04） cm/s and （8.74 ± 1.32） cm/s,P 〈 0.05 ]. Conclusion Tissue Doppler provides a new sensitive and early method to evaluate LV function in monitoring epirubiein cardiac toxicity as compared to the conventional eehoeardiography, and diastolic parameter alters earlier than systolic parameter.