舒张期纵向应变率早期评估蒽环类化疗药物对左心室舒张功能的影响

Early Evaluation of Cardiotoxicity Using Longitudinal Strain Imaging Diastolic Index in Patients with Anthracycline Chemotherapy

目的运用二维斑点追踪技术(two-dimensional speckle tracking imaging,2D-STI)获取使用蒽环类药物化学治疗(以下简标化疗)的乳腺癌患左心室舒张期应变参数,寻找能评估蒽环类药物化学治疗(以下简称化疗)致心肌早期舒张功能损伤的最有效的指标。方法选取笔者医院新诊断乳腺癌患者36例,并且所有患者均使用表柔比星化疗,在患者化疗前(T0)和化疗第2周期后(T2)及第4周期后(T4)用二维超声心动图检查并储存清晰图像。脉冲组织多普勒(PW-TDI)获取二尖瓣环间隔壁及侧壁位点舒张期运动速度e1、a1、e2、a2,计算平均e、平均a、平均E/e,2D-STI分析获取左心室收缩期纵向峰值应变(GLS)、左心室收缩期纵向峰值应变率(LSRs)、舒张早期及晚期纵向峰值应变率(LSRa、LSRe),计算LSRe/LSRa、E/LSRe。结果 (1)收缩功能参数:与化疗前比较,LVEF在T4周期化疗后的差异有统计学意义;与化疗前比较,GLS及LSRs在T2周期及T4周期化疗后差异均有统计学意义。(2)组织多普勒舒张功能参数:与化疗前比较,e1、a1、e2、平均e、平均E/e在T4周期化疗后比较,差异有统计学意义。(3) 2D-STI获取舒张功能参数:与化疗前比较,LSRe及E/LSRe在T2周期及T4周期化疗后比较,差异均有统计学意义;与化疗前比较,LSRa、LSRe/LSRa在T4周期化疗后比较,差异有统计学意义。(4) E/LSRe与表柔比星累计剂量呈正相关(r=0. 58,P=0. 000);绘制ROC曲线表明E/LSRe对蒽环类化疗药物致心肌收缩功能损伤有预测价值,当E/LSRe≥92. 4mc时,预测蒽环类药物化疗后收缩功能减低的敏感度和特异性分别为66. 7%、72. 5%。结论用2D-STI获取舒张期纵向应变值及应变率可早期发现现使用蒽环类化疗药物乳腺癌患者左心室舒张功能损伤,尤其是E/LSRe可作为左心室舒张早期功能损伤的敏感参数,并且该参数可预测心肌收缩功能的损伤。

Objective To evaluate left ventricular diastolic function and investigate the value of 2D-STI in evaluation the early myocardial toxicity of anthracycline chemotherapy.Methods A total number of 36 patients newly diagnosed with breast cancer and preparing for epirubicin therapy were prospectively enrolled.PW-TDI(Pulsed wave tissue Dopper imaging)datas included:diastolic velocity e1,a1,and e2,a2 at septal or lateral sites of mitral annulus,average e,average a and average E/e at baseline(T0),after the second cycle(T2)and after the four cycle(T4)with epirubicin.The left ventricular strain parameters by EchoPAC analysis software included:global longitudinal strain(GLS),global longitudinal strain rate(LSRs),longitudinal peak strain rate in early diastole(LSRe),longitudinal peak strain rate in late diastole(LSRa)and LSRe/LSRa,E/LSRe.Results①Systolic function parameters:LVEF at T4 was significantly different from it at T0(P<0.05).GLS and LSRs at T2 and T4 were significantly lower than those at T0(all P<0.05).②diastolic function parameters:average E/e at T4 was significantly different from it at T0(P<0.05).The index including LSRe,E/LSRe were significantly different between T0 and T2 and between T0 and T4(all P<0.05);while the variation of LSRa,LSRe/LSRa were statistical significances between T0 and T4(all P<0.05).③The correlation analysis showed that there were positive correlations between accumulative dose of epirubicin and E/LSRe(r=0.58,P=0.000)in breast cancer patients.The area under curve of E/LSRe for predicting left ventricular systolic dysfunction was 71.0%.The sensitivity and specificity were 66.7%and 72.5%using a cutoff value of E/LSRe≥92.4cm.Conclusion Strain parameters in diastole especially E/LSRe obtained by 2D-STI can accurately analyze the left ventricular diastolic function and can sensitively detecte the early myocardial toxicity in patients with anthracycline chemotherapy.