实时三维斑点追踪成像评价乳腺癌蒽环类化疗对左心室功能的影响

Real-time Three-dimensional Speckle Tracking Imaging in Assessment of the Impact of Breast Cancer Anthracycline-based Chemotherapy on Left Ventricular Function

目的探讨实时三维斑点追踪成像(RT3D-STI)评价应用蒽环类化疗药物的乳腺癌患者左心室功能的价值。资料与方法对59例应用6个周期蒽环类药物化疗的乳腺癌患者进行随访,于化疗前、化疗第2、4、6个周期后行常规超声心动图及RT3DSTI检查,观察常规二维参数及RT3D-STI参数:三维应变(3DS)、整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)、左心室扭转角度(LVtw)以及左心室射血分数(LVEF),计算心肌综合指数(MCI)。对比化疗前后不同周期常规参数、RT3D-STI参数,绘制RT3D-STI相关参数受试者工作特征曲线,并比较RT3D-STI各参数与药物累积剂量之间的相关性。结果①二维常规参数:与对照组及化疗前比较,化疗第6周期E/A、Em、Em/Am较低(P<0.05)。②三维参数:与对照组及化疗前比较,LVtw、MCI在化疗第2、4、6周期较低(P<0.05);3DS、GLS在化疗第4、6周期较低(P<0.05);LVEF在第6周期减低(P<0.05)。③LVtw、MCI的受试者工作特征曲线下面积分别为0.891、0.873,MCI敏感度为98.3%,LVtw特异度为75.7%。④LVtw、MCI、3DS与药物剂量呈显著负相关(r=-0.803、-0.776、-0.768,P<0.01)。结论RT3D-STI可早期监测蒽环类化疗药物对乳腺癌患者左心室功能的影响。

Purpose To investigate the value of real-time three-dimensional speckle tracking imaging (RT3D-STI) in the assessment of left ventricular function in breast cancer patients with anthracycline-based chemotherapy. Materials and Methods Fifty-nine breast cancer patients who underwent 6 cycles of anthracycline-based chemotherapy were followed up, and routine echocardiography and RT3DSTI examination were performed before chemotherapy and after 2nd, 4th and 6th cycle of chemotherapy to observe the routine twodimensional parameters and RT3D-STI parameters: three-dimensional strain (3DS), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), left ventricular twist angle (LVtw) and left ventricular ejection fraction (LVEF), and then myocardial composite index (MCI) was calculated. The routine parameters and RT3D-STI parameters of different cycles before and after chemotherapy were compared to plot the ROC curve of RT3D-STI related parameters, and further the correlation between each parameter of RT3D-STI and drug cumulative dose was compared. Results ①Two-dimensional routine parameters: compared with the control group and before chemotherapy, the E/A, Em and Em/Am in the 6th cycle of chemotherapy were lower (P<0.05).②Three-dimensional parameters: compared with the control group and before chemotherapy, LVtw and MCI were lower in the 2nd, 4th and 6th cycle of chemotherapy (P<0.05), 3DS and GLS were lower in the 4th and 6th cycle of chemotherapy (P<0.05), and LVEF was decreased in the 6th cycle (P<0.05).③The area under the ROC curve of LVtw and MCI was 0.891 and 0.873, respectively. The sensitivity of MCI was 98.3%, and the specificity of LVtw was 75.7%.④LVtw, MCI and 3DS showed a strong negative correlation with the drug dose (r=-0.803,-0.776,-0.768, P<0.01). Conclusion RT3D-STI could early monitor the impact of anthracycline-based chemotherapy drugs on left ventricular function in breast cancer patients.