三维斑点追踪整体面积应变是乳腺癌蒽环类药物化疗患者早期心肌受损的良好预测指标

3D speckle tracking echocardiography derived global area strain: a good predictor in patients with breast cancer during the anthracycline chemotherapy cycles

目的评价左室三维斑点追踪参数预测乳腺癌患者蒽环类药物化疗后心肌受损及高敏肌钙蛋白增高2倍的价值。方法 83例无心脏疾病症状和体征进行6或8个周期包括蒽环类药物化疗在内多种方案治疗的乳腺癌患者纳入本次研究,分别于化疗前、化疗周期半程、化疗周期结束时采用标准二维及多普勒超声测量左室舒张末容量(LVEDV)、收缩末容量(LVEDV)、射血分数(LVEF)及二尖瓣舒张期早期和晚期血流速比值(E/A),再应用三维斑点追踪技术测量整体面积应变(GAS)、整体长轴应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS),并同时测量血清高敏肌钙蛋白T(Hs-cTnT)。结果化疗开始至结束,血清肌钙蛋白明显升高但仍在正常值范围内,GAS、GCS、GLS、E/A也都轻度减低,而LVESV、LVEDV、LVEF和GRS化疗后并没有明显改变。Pearson相关性分析显示只有GAS与Hs-cTnT呈明显负相关性(r=-0. 34,P <0. 0001)。无论是在比较蒽环类药物化疗前、后还是血清高敏肌钙蛋白浓度从基础值升高2倍时心功能相关参数变化方面,GAS曲线下面积都是最大的(分别是0. 93 and 0. 74)。以GAS-30. 5%为截断值,化疗后与化疗前比较,敏感性为85. 7%,特异性为89. 2%,准确性为87. 6%。预测Hs-cTnT浓度升高2倍的敏感性为75. 1%,特异性为62. 9%,准确性为70. 3%。结论三维斑点追踪整体面积应变参数对于Hs-cTnT浓度增高在正常范围值内的乳腺癌蒽环类药物化疗患者心功能损害具有良好的预测价值,为早期发现化疗药物心脏毒性的亚临床损害、及时进行心脏保护性治疗措施提供了有效的保证。

Objective To compare the performance of three-dimensional speckle tracking echocardiography(3D STE)derived left ventricular strain parameters in discriminating between before and after anthracycline chemotherapy and predicting a twice serum high-sensitivity cardiac troponin T(Hs-cTnT)level as much as baseline.Methods Eighty-three patients with breast cancer,free of cardiac symptoms/signs,were enrolled in this study,who had underwent multiple treatment protocols including anthracycline chemotherapy for 6 cycles.Standard 2D and Doppler echo with measurements of left ventricular end-diastolic volume(LVEDV),end-systolic volume(LVESV),ejection fraction(LVEF)and the ratio of the mitral early to late diastolic flow velocity(E/A)and 3D STE with measurements of global area strain(GAS),global longitudinal strain(GLS),global circumferential strain(GCS)and global radial strain(GRS)as well as serum Hs-cTnT test was performed at baseline,at the end of the third and sixth chemotherapy cycles,respectively.Results From baseline to the sixth chemotherapy cycles,serum Hs-cTnT concentrations were markedly increased in turn although they were still within the normal reference range,and GAS,GCS,GLS,E/A ratio were all slightly reduced in turn,too.While,LVESV,LVEDV,LVEF and GRS were not significantly changed after chemotherapy.The Pearson correlation analysis showed that only GAS correlated significantly with Hs-cTnT(r=-0.34,P<0.000 1).No matter discriminating between before and after anthracycline chemotherapy or predicting a twice serum Hs-cTnT level as much as baseline,the areas under receiver operating characteristic curve(AUC)for GAS were all maximal(0.93 and 0.74,respetively).The cutoff value with-30.5%of GAS had sensitivity of 85.7%,specificity of 89.2%and accuracy of 87.6%for differentiating patients after therapy from baselines,and had sensitivity of 75.1%,specificity of 62.9%and accuracy of 70.3%for predicting a twice serum Hs-cTnT level as much as baseline.Conclusion 3D STE derived GAS is a good predictor of increased serum high-sensitivity cardiac troponin T concentrations even within the normal reference range in patients with breast cancer during the anthracycline chemotherapy cycles,which holds considerable clinical promise for detecting subclinical chemotherapy-related cardiotoxicity,and for initiating cardioprotective therapy without delay.