重复测量分析左心房最小容积与最大容积在评价蒽环类药物所致心脏毒性中的应用价值

Evaluation of left atrial minimum volume and left atrial maximum volume in assessing anthracycline-induced cardiotoxity:a repeated measurement analysis

目的:探讨采用三维超声心动图技术(3DE)测量左房最大容积(LAVmax)与左房最小容积(LAVmin)在评价蒽环类药物心脏毒性中的应用价值。方法:对53例右乳切除术后乳腺癌患者在以阿霉素为主的联合化疗前及每次化疗后,测量左心房前后径(LAD1)、左右径(LAD2)、上下径(LAD3)、二尖瓣口E峰与二尖瓣环侧壁组织多普勒e’峰比值(E/e’);应用3DE技术测量LAVmax、LAVmin、左房射血量(LASV)及左心房扩张指数(LAEI)。分析左房容积参数与E/e’的相关性,比较以上指标在化疗前后有无差异。结果:第1次化疗后E/e’与化疗前比较无明显变化,第2、第3及第4次化疗后E/e’均较第1次化疗前增大(P<0.05),其余二维测量左房参数在化疗前后差异均无统计学意义(P>0.05)。每次化疗后LAVmin与第1次化疗前比较差异均有统计学意义(P<0.05),LAVmax在第2、第3及第4次化疗后与第1次化疗前比较差异均有统计学意义(P<0.05)。LASV及LAEI化疗前后差异均无统计学意义(P>0.05)。LAVmin、LAVmax与E/e’存在显著相关性(P<0.01),相关系数分别为0.677、0.603。结论:通过3DE测量左房LAVmin和LAVmax与左室舒张功能存在显著相关性,可定量评价蒽环类药物引起的心脏毒性。

Objective： To investigate the value of left atrial minimum volume and left atrial maximum vol-ume by three-dimensional echocardiography （3DE） in evaluating anthracycline-induced cardiotoxity in breast cancer patients receiving chemotherapy. Methods： The study consisted of 53 patients who were diagnosed as breast cancer and then underwent doxorubicin chemotherapy after right breast mastectomy. Conventional echo-cardiographic parameters including left atrial diameters, ratio of early （E） by Doppler recordings from mitral inflow and peak early diastolic velocity （e’） of lateral mitral annulus by tissue Doppler imaging （E/e’） were performed at baseline and after every cycle of chemotherapy. Left atrial volume parameters including left atrial volume maximum index （LAVmax）, left atrial minimum volume index （LAVmin）, left atrial ejection volume （LASV）, left atrial expansion index （LAEI） were obtained at the same time by 3DE. The above parameters were compared between baseline and after every cycles. Results： Compared with baseline, E/e’ had statistical differ-ence after second to fourth cycle （P〈0.05）. There were no signifcant changes in E/e’ after the frst chemotherapy （P〉0.05）. Compared with baseline, conventional echocardiography parameters had no statistically changes. There were statistical differences in LAVmin after every cycle of chemotherapy and in LAVmax after T2, T3 and T4. There was no statistical difference in LASV, LAEI after every cycle of chemotherapy （P〉0.05）. There were signifcant correlations between LAVmin, LAVmax and E/e’（P〈0.01）, with correlation coeffcients being 0.677 and 0.603 respectively. Conclusion： LAVmax and LAVmin are better parameters in monitoring anthracy-cline chemotherapy-associated cardiotoxicity and have signifcant correlations with diastolic function of the left ventricle.