纵向分层应变技术评估蒽环类药物化疗后乳腺癌患者左心收缩功能

Longitudinal layer-specific strain technology in evaluation on left ventricular systolic function of breast carcinoma patients treated with anthracyclines

目的应用二维分层应变技术评估蒽环类药物化疗后乳腺癌患者早期左心室收缩功能的变化。方法收集接受蒽环类药物化疗的乳腺癌患者32例及未接受化疗的乳腺癌术后患者20例。化疗患者于化疗3个月、5个月后接受常规超声心动图采集图像,应用EchoPAC软件测量左心室长轴各切面收缩期心内膜下、中层和心外膜下心肌的整体纵向应变(GLS)及各节段(基底段、中间段、心尖段)的纵向应变。结果与对照组比较,随着化疗周期的增加,蒽环类药物化疗后乳腺癌患者心内膜下、中层和心外膜下心肌GLS均减低(P均<0.05),而左心室射血分数(LVEF)无显著差异(P>0.05);与对照组比较,除各层心肌心尖段外,化疗后患者各层心肌基底段、中间段纵向应变减低(P均<0.05)。结论纵向分层应变技术可准确评估乳腺癌蒽环类药物化疗后左心各层心肌整体及局部收缩功能,为判断心肌损伤程度提供了新的方法。

Objective To evaluate left ventricular global longitudinal strain in endocardium,middle myocardium and epicardium of patients with breast carcinoma treated with anthracyclines by two-dimensional layered strain technology.Methods Totally 20 breast cancer patients after surgery without chemotherapy（control group）and 32 breast cancer patients who were treated with anthracycline-based chemotherapy were enrolled.The patients treated with chemotherapy were performed transthoracic echocardiography 3 months and 5 months after chemotherapy.Global longitudinal strain（GLS）and each segment（apex,basis and media section）strain in 3 myocardial layers（endocardium,middle myocardium and epicardium）were measured by EchoPAC software.Results Compared with control group,with the extension of chemotherapy cycle,GLS of 3myocardial layers reduced in breast carcinoma patients treated with anthracyclines（all P〈0.05）,but left ventricular ejection fraction（LVEF）had no statistical difference（P〉0.05）.Compared with control group,each layer of each segment of longitudinal strain decreased in breast carcinomapatients treated with anthracyclines（all P〈0.05）,except the apex section.Conclusion Longitudinal layer-specific strain technology can accurate assess whole and local systolic function of 3 myocardial layers of left ventricular,which can provide a new method for judging myocardial damage.