三维超声心动图应变参数在早期检测蒽环类药物心脏毒性中的价值

【摘要】目的探讨三维超声心动图应变参数早期检测蒽环类药物心脏毒性的价值。方法应用三维超声心动图斑点追踪技术对30例接受蒽环类药物化疗的患者分别在化疗前基础状态、3个化疗周期完成时和6个化疗周期完成时进行左室整体收缩功能的评估。分别测量左室整体长轴应变（3DGLS）、圆周应变（3DGCS）、径向应变（3DGRS）、面积应变（3DGAS），将3个周期完成时和6个周期完成时数据与基础状态进行比较。结果3DGAS、3DGLS在3个周期和6个周期完成时较基础状态减低，差异有统计学意义（P〈0．05）。3DGCS、3DGRS在6个周期完成时较基础状态减低，差异有统计学意义（P〈0．05），3DGCS、3DGRS在3个周期完成时较基础状态有所减低，但差异无统计学意义（P〉0．05）。结论三维斑点追踪应变是早期评价蒽环类药物心脏毒性的敏感的无创方法，有助于筛选需要密切监测的患者，以便早期保护心脏治疗或减低化疗药物剂量，以免引起不可逆的心脏功能障碍。

Objective To explore the value of three-dimensional echocardiographic strain parameters in the early detection of anthracycline- induced cardiotoxicity. Methods A population of 30 subjects receiving anthracycline chemotherapy were investigated for left ventricular global systolic function using three-dimensional echocardiographic speckle-tracking strains at baseline, 3 periods and 6 periods after the chemotherapy. Three- dimensional global longitudinal strain （ 3DGLS ） , circumferential （ 3DGCS ） , radial （ 3DGRS ） , and area strains （ 3DGAS ） were measured. 3D strain parameters at the time of 3 periods and 6 periods after chemotherapy were compared with those at baseline. Results 3DGAS, 3DGLS deteriorated at the time of 3 periods and 6 periods after chemotherapy compared with those at baseline （ P〈0.05 ） . 3DGCS, 3DGRS deteriorated at the time of 6 periods after chemotherapy compared with those at baseline （ P〈0.05 ） . Though 3DGCS, 3DGRS decreased at the time of 3 periods after chemotherapy, there was no statistical difference compared with those at baseline （ P〉0.05 ） . Conclusion Three-dimensional speckle-tracking strain appears to be a useful non-invasive method for the early detection of anthracycline-induced myocardial damage. It may help target patients who could benefit from closer cardiac monitoring, earlier initiation of cardioprotective medical therapy, or fewer anticancer drugs, in order to prevent the progression to an irreversible stage of cardiac dysfunction.